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Easy German Essays for Beginners: 8 Examples to Practice Your Language Skills

Are you a beginner in learning German and looking for ways to practice your language skills? One great way to do so is by writing essays in German. Writing essays not only improves your grammar and vocabulary but also helps you express your thoughts and ideas in the target language. In this article, we will provide you with eight easy German essays for Beginners with English translation and vocabulary to help you get started.

• Meine Familie (My family) – Write about your family, including their names, occupations, and hobbies.
• Mein Haus (My house) – Describe your house or apartment, including the number of rooms, furniture, and decorations.
• Meine Hobbys (My hobbies) – Talk about your favorite hobbies, such as playing sports, reading books, or listening to music.
• Meine Schule (My school) – Write about your school, including its location, teachers, and subjects you study.
• Meine Freunde (My friends) – Discuss your friends, including how you met them, their personalities, and what you like to do together.
• Meine Stadt (My city) – Describe your city or town, including its population, tourist attractions, and cultural events.
• Meine Reise (My trip) – Write about a recent trip you took, including the destination, transportation, and activities you did there.
• Meine Lieblingsessen (My favorite food) – Talk about your favorite foods, including traditional German dishes and other international cuisines.

Remember to use simple vocabulary and sentence structures while writing the essays. Good luck with your German learning journey!

Table of Contents

Meine familie (my family).

Ich heiße Maria und ich möchte euch gerne meine Familie vorstellen. Wir sind insgesamt vier Personen in meiner Familie. Mein Vater heißt Klaus und er arbeitet als Ingenieur. Meine Mutter heißt Petra und sie ist Hausfrau. Mein Bruder heißt Jan und er geht noch zur Schule.

(My name is Maria, and I would like to introduce you to my family. We are a family of four. My father’s name is Klaus, and he works as an engineer. My mother’s name is Petra, and she is a homemaker. My brother’s name is Jan, and he still goes to school.)

Vocabulary:

• Ich heiße Maria (My name is Maria)
• insgesamt (altogether)
• vier Personen (four persons)
• der Vater (father)
• arbeiten (to work)
• der Ingenieur (engineer)
• die Mutter (mother)
• Hausfrau (homemaker)
• der Bruder (brother)
• noch zur Schule gehen (still go to school)

Mein Vater arbeitet in einem großen Unternehmen als Ingenieur. Er ist sehr fleißig und verbringt viel Zeit im Büro. In seiner Freizeit geht er gerne joggen oder spielt Golf. Meine Mutter kümmert sich um den Haushalt und verbringt viel Zeit damit, leckere Mahlzeiten zu kochen. Sie liest auch gerne Bücher und geht regelmäßig zum Yoga.

(My father works in a large company as an engineer. He is very hardworking and spends a lot of time in the office. In his free time, he likes to go jogging or play golf. My mother takes care of the household and spends a lot of time cooking delicious meals. She also likes to read books and regularly attends yoga classes.)

• in einem großen Unternehmen (in a large company)
• sehr fleißig (very hardworking)
• viel Zeit (a lot of time)
• im Büro (in the office)
• in seiner Freizeit (in his free time)
• joggen (to go jogging)
• Golf spielen (to play golf)
• sich kümmern um (to take care of)
• der Haushalt (household)
• leckere Mahlzeiten kochen (cook delicious meals)
• gerne lesen (like to read)
• regelmäßig (regularly)
• zum Yoga gehen (go to yoga)

Mein Bruder Jan geht noch zur Schule und ist sehr sportlich. Er spielt Fußball im Verein und geht regelmäßig ins Fitnessstudio. In seiner Freizeit hört er gerne Musik und schaut Filme.

(My brother Jan still goes to school and is very sporty. He plays soccer in a club and regularly goes to the gym. In his free time, he likes to listen to music and watch movies.)

• sehr sportlich (very sporty)
• Fußball spielen (to play soccer)
• im Verein (in a club)
• ins Fitnessstudio gehen (to go to the gym)
• Musik hören (listen to music)
• Filme schauen (watch movies)

Ich studiere im Moment an der Universität und meine Hobbys sind Lesen, Reisen und Yoga. In meiner Freizeit gehe ich gerne in die Natur und genieße die frische Luft.

(I am currently studying at the university, and my hobbies are reading, traveling, and yoga. In my free time, I like to go into nature and enjoy the fresh air.)

• studieren (to study)
• an der Universität (at the university)
• die Hobbys (hobbies)
• Lesen (reading)
• Reisen (traveling)
• Yoga (yoga)
• die Freizeit (free time)
• in die Natur gehen (go into nature)
• genießen (enjoy)
• frische Luft (fresh air)

Das ist meine Familie. Wir haben viele verschiedene Hobbys und Interessen, aber wir verbringen auch gerne gemeinsam Zeit miteinander.

(This is my family. We have many different hobbies and interests, but we also enjoy spending time together.)

• das ist (this is)
• verschiedene Hobbys und Interessen (different hobbies and interests)
• gerne Zeit miteinander verbringen (enjoy spending time together)

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Mein Haus (My House)

Ich lebe in einem Haus mit drei Schlafzimmern und zwei Bädern. Das Haus ist zweistöckig und hat auch einen Keller. Im Erdgeschoss befinden sich das Wohnzimmer, die Küche und ein Esszimmer. Im Wohnzimmer haben wir ein bequemes Sofa und einen großen Fernseher. In der Küche gibt es eine Spülmaschine, einen Herd, einen Backofen und einen Kühlschrank. Das Esszimmer hat einen Esstisch mit sechs Stühlen.

(I live in a house with three bedrooms and two bathrooms. The house is two stories and also has a basement. On the ground floor, there is the living room, kitchen, and a dining room. In the living room, we have a comfortable sofa and a large television. In the kitchen, there is a dishwasher, stove, oven, and refrigerator. The dining room has a dining table with six chairs.)

• das Haus (house)
• die Schlafzimmer (bedrooms)
• die Bäder (bathrooms)
• zweistöckig (two-storied)
• der Keller (basement)
• das Erdgeschoss (ground floor)
• das Wohnzimmer (living room)
• die Küche (kitchen)
• das Esszimmer (dining room)
• ein bequemes Sofa (a comfortable sofa)
• ein großer Fernseher (a large television)
• eine Spülmaschine (a dishwasher)
• ein Herd (a stove)
• ein Backofen (an oven)
• ein Kühlschrank (a refrigerator)
• ein Esstisch (a dining table)
• sechs Stühle (six chairs)

Im Obergeschoss befinden sich die Schlafzimmer und die Bäder. Mein Schlafzimmer hat ein großes Bett, einen Schreibtisch und einen Kleiderschrank. Das Badezimmer hat eine Badewanne und eine Dusche. In den anderen Schlafzimmern gibt es auch Betten und Schränke für Kleidung.

(Upstairs, there are the bedrooms and bathrooms. My bedroom has a large bed, a desk, and a closet. The bathroom has a bathtub and a shower. In the other bedrooms, there are also beds and closets for clothes.)

• das Obergeschoss (upper floor)
• das Schlafzimmer (bedroom)
• der Schreibtisch (desk)
• der Kleiderschrank (closet)
• das Badezimmer (bathroom)
• die Badewanne (bathtub)
• die Dusche (shower)
• die anderen Schlafzimmer (the other bedrooms)

Im Keller haben wir eine Waschmaschine und einen Trockner. Wir nutzen den Keller auch als Lager für Dinge, die wir nicht oft brauchen.

(In the basement, we have a washing machine and dryer. We also use the basement as a storage area for things we don’t need often.)

• die Waschmaschine (washing machine)
• der Trockner (dryer)
• als Lager nutzen (use as storage area)
• Dinge (things)

Wir haben auch einige Dekorationen im Haus. Im Wohnzimmer haben wir ein großes Gemälde an der Wand und im Esszimmer steht eine Vase mit Blumen auf dem Tisch.

(We also have some decorations in the house. In the living room, we have a large painting on the wall, and in the dining room, there is a vase of flowers on the table.)

• die Dekorationen (decorations)
• das Gemälde (painting)
• die Wand (wall)
• die Vase (vase)
• die Blumen (flowers)
• der Tisch (table)

Wir haben auch ein paar Teppiche im Haus, um den Boden zu bedecken. Das Wohnzimmer hat einen braunen Teppich, während die Schlafzimmer jeweils einen unterschiedlichen Farbton haben. Mein Schlafzimmer hat einen blauen Teppich, während das andere Schlafzimmer einen roten Teppich hat.

(We also have some carpets in the house to cover the floor. The living room has a brown carpet, while the bedrooms have a different color tone each. My bedroom has a blue carpet, while the other bedroom has a red carpet.)

• der Teppich (carpet)
• den Boden bedecken (to cover the floor)
• unterschiedliche Farbton (different color tone)

Insgesamt bin ich sehr glücklich mit meinem Haus. Es ist gemütlich und hat genug Platz für meine Familie und mich.

(Overall, I am very happy with my house. It is cozy and has enough space for my family and me.)

• insgesamt (overall)
• glücklich (happy)
• gemütlich (cozy)
• genug Platz (enough space)

Difference between ein, eine, einen, and einem in the German Language

Meine hobbys (my hobbies).

Ich habe einige Hobbys, die ich sehr gerne mache. Eines meiner Lieblingshobbys ist es, Sport zu treiben. Insbesondere mag ich es, Basketball zu spielen und Laufen zu gehen. Ich liebe es, im Freien zu sein und Sport zu treiben, weil es mir hilft, mich fit und gesund zu halten.

(I have some hobbies that I really enjoy doing. One of my favorite hobbies is doing sports. In particular, I like to play basketball and go running. I love being outdoors and doing sports because it helps me stay fit and healthy.)

• das Hobby (hobby)
• Sport treiben (to do sports)
• Basketball spielen (to play basketball)
• Laufen gehen (to go running)
• im Freien sein (to be outdoors)
• fit und gesund (fit and healthy)

Ein weiteres Hobby von mir ist das Lesen von Büchern. Ich lese gerne Romane und Sachbücher, besonders über Geschichte und Wissenschaft. Lesen ist für mich eine Möglichkeit, zu lernen und meine Vorstellungskraft zu erweitern.

(Another hobby of mine is reading books. I enjoy reading novels and non-fiction books, especially about history and science. Reading is a way for me to learn and expand my imagination.)

• das Lesen (reading)
• das Buch (book)
• der Roman (novel)
• das Sachbuch (non-fiction book)
• die Geschichte (history)
• die Wissenschaft (science)
• die Vorstellungskraft (imagination)

Außerdem höre ich gerne Musik. Ich mag viele verschiedene Genres wie Pop, Rock und Klassik. Musik kann meine Stimmung beeinflussen und mich entspannen.

(Additionally, I like to listen to music. I enjoy many different genres like pop, rock, and classical. Music can influence my mood and help me relax.)

• die Musik (music)
• das Genre (genre)
• Pop, Rock, Klassik (pop, rock, classical)
• die Stimmung (mood)
• sich entspannen (to relax)

Insgesamt bin ich sehr dankbar für meine Hobbys. Sie helfen mir, meinen Geist und Körper gesund zu halten und mich zu entspannen.

(Overall, I am very grateful for my hobbies. They help me keep my mind and body healthy and help me relax.)

• dankbar (grateful)
• der Geist (mind)
• der Körper (body)

German Essays on My Family: Meine Familie

Meine schule (my school).

Ich besuche eine Schule in der Nähe meines Hauses. Die Schule ist relativ groß und hat viele Schülerinnen und Schüler. Wir haben viele Lehrerinnen und Lehrer, die alle sehr nett und hilfsbereit sind.

(I attend a school near my house. The school is relatively large and has many students. We have many teachers who are all very kind and helpful.)

• besuchen (to attend)
• die Nähe (proximity)
• relativ (relatively)
• die Schülerin (female student)
• der Schüler (male student)
• viele (many)
• die Lehrerin (female teacher)
• der Lehrer (male teacher)
• nett (kind)
• hilfsbereit (helpful)

Die Schule bietet viele verschiedene Fächer an, einschließlich Mathematik, Geschichte, Englisch, Naturwissenschaften und Fremdsprachen. Mein Lieblingsfach ist Englisch, weil ich gerne Geschichten lese und schreibe. Ich denke, dass es wichtig ist, eine gute Ausbildung zu haben, um im Leben erfolgreich zu sein.

(The school offers many different subjects, including mathematics, history, English, science, and foreign languages. My favorite subject is English because I enjoy reading and writing stories. I believe that having a good education is important to be successful in life.)

• das Fach (subject)
• einschließlich (including)
• Mathematik (mathematics)
• Geschichte (history)
• Englisch (English)
• Naturwissenschaften (science)
• Fremdsprachen (foreign languages)
• das Lieblingsfach (favorite subject)
• die Geschichte (story)
• die Ausbildung (education)
• erfolgreich (successful)

Unsere Schule hat auch viele außerschulische Aktivitäten, wie zum Beispiel Sportmannschaften und Musikgruppen. Ich bin Mitglied des Schulfußballteams und wir haben viele Spiele gegen andere Schulen in der Gegend. Es macht mir viel Spaß und ich habe viele Freunde durch das Team kennengelernt.

(Our school also has many extracurricular activities, such as sports teams and music groups. I am a member of the school soccer team and we have many games against other schools in the area. It’s a lot of fun and I have made many friends through the team.)

• außerschulisch (extracurricular)
• die Aktivitäten (activities)
• die Sportmannschaften (sports teams)
• die Musikgruppen (music groups)
• das Mitglied (member)
• das Schulfußballteam (school soccer team)
• das Spiel (game)
• die Gegend (area)
• der Spaß (fun)
• der Freund (friend)

Insgesamt bin ich sehr glücklich auf meiner Schule und ich denke, dass ich hier eine gute Ausbildung bekomme. Ich hoffe, dass ich in Zukunft noch mehr von den vielen Möglichkeiten, die die Schule bietet, profitieren kann.

(Overall, I am very happy at my school and I think that I am getting a good education here. I hope that in the future, I can take advantage of even more of the many opportunities that the school offers.)

• die Möglichkeit (opportunity)
• profitieren (to take advantage of)

List of German adjectives with English meaning

Meine Freunde (My friends)

Ich habe viele Freunde, aber ich möchte über meine drei engsten Freunde sprechen. Wir haben uns alle in der Grundschule kennengelernt und sind seitdem unzertrennlich.

(I have many friends, but I want to talk about my three closest friends. We all met in elementary school and have been inseparable ever since.)

• die Freunde (friends)
• unzertrennlich (inseparable)

Mein erster Freund heißt Max. Er ist sehr sportlich und spielt gerne Fußball und Basketball. Max ist auch sehr lustig und hat immer eine positive Einstellung. Wir lieben es, zusammen Sport zu treiben oder Videospiele zu spielen.

(My first friend is Max. He is very athletic and likes to play soccer and basketball. Max is also very funny and always has a positive attitude. We love to exercise or play video games together.)

• sportlich (athletic)
• Fußball (soccer)
• Basketball (basketball)
• die Einstellung (attitude)
• lustig (funny)
• zusammen (together)
• Videospiele (video games)

Meine Freundin Anna ist sehr künstlerisch und liebt es zu malen und zu zeichnen. Sie hat auch ein großes Herz und ist immer bereit, anderen zu helfen. Anna und ich machen oft zusammen Kunstprojekte oder gehen ins Kino.

(My friend Anna is very artistic and loves to paint and draw. She also has a big heart and is always willing to help others. Anna and I often do art projects together or go to the movies.)

• künstlerisch (artistic)
• malen (to paint)
• zeichnen (to draw)
• das Herz (heart)
• bereit (willing)
• helfen (to help)
• das Kunstprojekt (art project)
• ins Kino gehen (to go to the movies)

Mein Freund Tom ist sehr intelligent und liebt es, neue Dinge zu lernen. Er ist auch sehr abenteuerlustig und geht gerne auf Reisen. Tom und ich haben viele spannende Abenteuer erlebt, wie zum Beispiel Campingausflüge oder Klettertouren.

(My friend Tom is very smart and loves to learn new things. He is also very adventurous and likes to travel. Tom and I have had many exciting adventures, such as camping trips or climbing expeditions.)

• intelligent (smart)
• abenteuerlustig (adventurous)
• die Reise (travel)
• die Abenteuer (adventures)
• der Campingausflug (camping trip)
• die Klettertour (climbing expedition)

Insgesamt bin ich sehr dankbar für meine Freunde und bin froh, dass ich sie habe. Wir haben so viele schöne Erinnerungen zusammen gemacht und ich freue mich auf viele weitere Abenteuer mit ihnen.

(Overall, I am very grateful for my friends and am glad to have them. We have made so many beautiful memories together and I look forward to many more adventures with them.)

• froh (glad)
• die Erinnerungen (memories)

Meine Stadt (My city)

Ich lebe in einer Stadt namens Hamburg in Deutschland. Hamburg ist die zweitgrößte Stadt Deutschlands und hat eine Bevölkerung von etwa 1,8 Millionen Menschen. Es ist eine Hafenstadt und liegt an der Elbe.

(I live in a city called Hamburg in Germany. Hamburg is the second largest city in Germany and has a population of about 1.8 million people. It is a port city and located on the river Elbe.)

• die Bevölkerung (population)
• der Hafen (port)
• die Elbe (river Elbe)

Hamburg ist bekannt für seine vielen Touristenattraktionen. Eines der bekanntesten ist der Hamburger Hafen, der einer der größten Häfen Europas ist. Es gibt auch den Fischmarkt, auf dem man frischen Fisch kaufen und lokale Spezialitäten probieren kann.

(Hamburg is known for its many tourist attractions. One of the most famous is the Port of Hamburg, which is one of the largest ports in Europe. There is also the Fish Market, where you can buy fresh fish and try local specialties.)

• die Touristenattraktionen (tourist attractions)
• bekannt (known)
• der Fischmarkt (fish market)
• frisch (fresh)
• lokale Spezialitäten (local specialties)

Außerdem gibt es viele kulturelle Veranstaltungen in Hamburg. Jedes Jahr findet das Hamburger Domfest statt, das größte Volksfest im Norden Deutschlands. Es gibt auch das Internationale Filmfest Hamburg, bei dem Filme aus der ganzen Welt gezeigt werden.

(Additionally, there are many cultural events in Hamburg. Every year, the Hamburg Dom Festival takes place, which is the largest folk festival in northern Germany. There is also the Hamburg International Film Festival, where films from all over the world are shown.)

• kulturelle Veranstaltungen (cultural events)
• das Domfest (folk festival)
• das Internationale Filmfest (international film festival)
• aus der ganzen Welt (from all over the world)

Insgesamt ist Hamburg eine lebendige und vielfältige Stadt, die für jeden etwas zu bieten hat.

(Overall, Hamburg is a vibrant and diverse city that has something to offer for everyone.)

• lebendig (vibrant)
• vielfältig (diverse)
• etwas zu bieten haben (to have something to offer)

My trip (Meine Reise)

Ich bin vor Kurzem mit meiner Familie nach Paris gereist. Wir sind direkt von unserer Stadt aus geflogen und kamen früh am Morgen in Paris an.

(I recently went on a trip to Paris with my family. We took a direct flight from our city and arrived in Paris early in the morning.)

• Vor Kurzem (recently)
• Die Reise (trip)
• Meine Familie (my family)
• Fliegen (to fly)
• Direkt (direct)
• Unsere Stadt (our city)
• Ankommen (to arrive)
• Früh (early)
• Am Morgen (in the morning)

Wir haben in einem Hotel im Herzen der Stadt gewohnt, in der Nähe vieler beliebter Sehenswürdigkeiten. Unser Hotelzimmer hatte eine tolle Aussicht auf den Eiffelturm, der nur einen kurzen Spaziergang entfernt war.

(We stayed in a hotel in the heart of the city, close to many popular tourist attractions. Our hotel room had a great view of the Eiffel Tower, which was just a short walk away.)

• das Hotel (hotel)
• die Stadt (city)
• die Nähe (proximity, closeness)
• die Sehenswürdigkeiten (tourist attractions)
• das Hotelzimmer (hotel room)
• die Aussicht (view)
• der Eiffelturm (Eiffel Tower)
• der Spaziergang (walk)

Während unseres Aufenthalts haben wir viele berühmte Wahrzeichen der Stadt besucht, darunter das Louvre-Museum und die Kathedrale Notre-Dame. Wir haben auch eine Bootsfahrt auf der Seine gemacht, was eine großartige Möglichkeit war, die Stadt aus einer anderen Perspektive zu sehen.

(During our stay, we visited many of the city’s famous landmarks, including the Louvre Museum and Notre-Dame Cathedral. We also went on a boat tour of the Seine River, which was a great way to see the city from a different perspective.)

• der Aufenthalt (stay)
• berühmte Wahrzeichen (famous landmarks)
• das Louvre-Museum (the Louvre Museum)
• die Kathedrale Notre-Dame (Notre-Dame Cathedral)
• die Bootsfahrt (boat tour)
• die Seine (the Seine River)
• aus einer anderen Perspektive (from a different perspective)

Eines der Highlights unserer Reise war das Probieren der köstlichen französischen Küche. Wir haben in vielen verschiedenen Restaurants und Cafés gegessen und alles von Croissants bis Escargots ausprobiert.

(One of the highlights of our trip was trying the delicious French cuisine. We ate at many different restaurants and cafes, and tried everything from croissants to escargots.)

• das Highlight (the highlight)
• die Reise (the trip)
• das Probieren (the trying/tasting)
• die köstliche französische Küche (the delicious French cuisine)
• das Restaurant (the restaurant)
• das Café (the café)
• alles (everything)
• der Croissant (the croissant)
• die Escargots (the escargots (snails))

Insgesamt war unser Trip nach Paris eine wunderbare Erfahrung. Wir haben die schönen Sehenswürdigkeiten, das leckere Essen und die reiche Kultur der Stadt genossen. Es war eine großartige Gelegenheit, Zeit mit meiner Familie zu verbringen und bleibende Erinnerungen zu schaffen.

(Overall, our trip to Paris was a wonderful experience. We enjoyed the beautiful sights, delicious food, and rich culture of the city. It was a great opportunity to spend time with my family and create lasting memories.)

• Insgesamt (Overall)
• Trip (trip)
• Paris (Paris)
• Eine wunderbare Erfahrung (A wonderful experience)
• Wir haben genossen (We enjoyed)
• Die schönen Sehenswürdigkeiten (The beautiful sights)
• Das leckere Essen (The delicious food)
• Die reiche Kultur der Stadt (The rich culture of the city)
• Eine großartige Gelegenheit (A great opportunity)
• Zeit mit meiner Familie zu verbringen (To spend time with my family)
• Bleibende Erinnerungen zu schaffen (To create lasting memories)

Meine Lieblingsessen (My favorite food)

Ich esse gerne viele verschiedene Arten von Essen und habe viele Lieblingsspeisen. Einige meiner Favoriten sind traditionelle deutsche Gerichte wie Schnitzel und Spätzle, Sauerkraut und Bratwurst.

(I like to eat many different types of food and have many favorite dishes. Some of my favorites are traditional German dishes like Schnitzel and Spätzle, Sauerkraut, and Bratwurst.)

• Lieblingsspeisen (favorite dishes)
• traditionelle deutsche Gerichte (traditional German dishes)
• Schnitzel (breaded and fried meat cutlets)
• Spätzle (soft egg noodles)
• Sauerkraut (fermented cabbage)
• Bratwurst (grilled or fried sausage)

Ich mag auch viele internationale Küchen, wie zum Beispiel italienische Pizza und Pasta, thailändisches Curry, indische Masala und japanisches Sushi.

(I also enjoy many international cuisines, such as Italian pizza and pasta, Thai curry, Indian masala, and Japanese sushi.)

• internationale Küchen (international cuisines)

Ein weiteres meiner Lieblingsessen ist mexikanisches Essen wie Tacos, Quesadillas und Guacamole. Die Kombination aus scharfen Gewürzen und frischen Zutaten macht das Essen zu einer Geschmacksexplosion.

(Another one of my favorite foods is Mexican cuisine like tacos, quesadillas, and guacamole. The combination of spicy seasonings and fresh ingredients makes the food a flavor explosion.)

• scharfe Gewürze (spicy seasonings)
• frische Zutaten (fresh ingredients)
• Geschmacksexplosion (flavor explosion)
• mexikanisches Essen (Mexican cuisine)
• Tacos (filled tortillas)
• Quesadillas (stuffed and grilled tortillas)
• Guacamole (dip made from mashed avocado)

Insgesamt genieße ich es, neue Gerichte und Küchen auszuprobieren und verschiedene Aromen und Texturen zu entdecken. Essen ist eine große Leidenschaft von mir und ich liebe es, zu kochen und neue Rezepte zu kreieren.

(Overall, I enjoy trying new dishes and cuisines and discovering different flavors and textures. Food is a big passion of mine, and I love to cook and create new recipes.)

• Aromen und Texturen (flavors and textures)
• Leidenschaft (passion)
• Rezepte (recipes)
• kochen (to cook)
• kreieren (to create)

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Conclusion:

In conclusion, writing essays in German can be a fun and effective way to improve your language skills. The eight essay examples provided in this article (Easy German Essays for Beginners) offer a range of topics that will help you practice your writing skills, expand your vocabulary, and gain confidence in your ability to express yourself in German. So why not try writing one of these essays today and see how much progress you can make in your German language journey?

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24 German Essay Phrases, Plus Tips on How to Write an Essay in German

We need to talk about your German essays.

Essay writing is a skill that you can learn in any language.

All you need is to brush up your vocabulary and follow a few simple strategies, and you’ll be well on your way to writing your first masterpiece.

This post will provide you with a list of useful German words and phrases to include in your next essay, plus the different types of German essays, a few writing strategies and even a sample essay at the end. 

German Essay Phrases

General explaining, ordering facts and ideas, demonstrating contrast, expressing your opinion, summarizing and concluding, what are german essays like, the different types of german essays, how to write an essay in german in 4 steps, 1. write down a list of words , 2. do your research, 3. make an outline using transition words, 4. write directly in german, an example of a german essay, and one more thing....

Download: This blog post is available as a convenient and portable PDF that you can take anywhere. Click here to get a copy. (Download)

Let’s start with the words and phrases themselves. As you’ll see, they’re grouped according to how and when you’ll use them. Let’s start off with some that will help you explain your arguments.

1. Weil (Because)

Daniel muss lernen, weil er morgen einen Test hat.

(Daniel has to study because he has a test tomorrow.)

2. Da (Because)

Daniel muss lernen, da er morgen einen Test hat.

3. Denn (Because)

Daniel muss lernen, denn er hat morgen einen Test.

(Daniel has to study because tomorrow he has a test.)

A quick note: Weil, da and denn are generally interchangeable. Keep in mind though that denn requires a different word order.

4. Damit (In order to; So that)

Lisa lernt viel, damit sie den Test besteht.

(Lisa is studying a lot in order to pass the test.)

5. Um (To; In order to)

Lisa lernt viel, um den Test zu bestehen.

(Lisa is studying a lot to pass the test.)

6. Im Grunde (Basically; Fundamentally)

Im Grunde ist Deutsch keine schwierige Sprache.

(Fundamentally, German is not a difficult language.)

7. Eigentlich (Actually)

Eigentlich ist Deutsch nicht so schwierig, wie es scheint.

(Actually, German is not as difficult as it seems.)

8. Ein Beispiel anführen  (To give an example)

Ich möchte ein Beispiel anführen .

(I would like to give an example.)

9. Dieses Beispiel zeigt, dass… (This example shows that…)

Dieses Beispiel zeigt, dass das Lernen einer Fremdsprache beim Reisen viele Vorteile hat.

(This example shows that studying a foreign language has many advantages when traveling.)

10. Erstens… zweitens… (Firstly… secondly…)

Erstens kann man sich auf Reisen besser verständigen und zweitens lernt man viele neue Leute kennen.

(Firstly, you can communicate better while traveling, and secondly, you meet many new people.)

11. Das Wichtigste ist…  (T he most important thing is…)

Das Wichtigste ist , die Angst vor der Sprache zu verlieren.

(The most important thing is to lose your fear of the language.)

12. Außer dem (Furthermore)

Außerdem kann man beim Reisen seine Sprachkenntnisse verbessern.

(Furthermore, you can improve your language knowledge while traveling.)

13. Nicht nur… sondern auch…  (Not only… but also…)

Nicht nur im Unterricht, sondern auch im Alltag kann man viel Deutsch lernen.

(Not only in class, but also in everyday life you can learn a lot of German.)

14. Obwohl (Even though)

Obwohl Anna viel lernt, hat sie Probleme mit der deutschen Grammatik.

(Even though Anna studies a lot, she has problems with German grammar.)

15. Allerdings (However)

Anna lernt gerne Deutsch, allerdings hat sie Probleme mit der Grammatik.

(Anna enjoys studying German; however, she has problems with the grammar.)

16. Trotz   (Despite)

Trotz ihrer Probleme mit der Grammatik lernt Anna gerne Deutsch.

(Despite her problems with German grammar, Anna enjoys studying German.)

17. Im Vergleich zu (In comparison to)

Im Vergleich zu Russisch ist Deutsch eine einfache Sprache.

In comparison to Russian, German is an easy language.

18. Im Gegensatz zu (In contrast to; Unlike)

Im Gegensatz zu Anna lernt Paul gerne neue Vokabeln.

Unlike Anna, Paul enjoys learning new vocabulary.

19. Meiner Meinung nach (In my opinion)

Meiner Meinung nach sollte jeder eine Fremdsprache lernen.

(In my opinion, everybody should study a foreign language.)

20. Ich bin der Ansicht, dass…  (I believe that…)

Ich bin der Ansicht, dass jeder eine Fremdsprache lernen sollte.

(I believe that everybody should study a foreign language.)

21. Ich finde es schade, dass…  (I think it’s a pity that…)

Ich finde es schade, dass die Schulen keine anderen Fremdsprachen unterrichten.

(I think it’s a pity that schools don’t teach other foreign languages.)

22. Alles in Allem (Overall)

Alles in allem ist Deutsch nicht so schwierig, wie es scheint.

(Overall, German isn’t as difficult as it seems.)

23. Im Großen und Ganzen (Overall)

Im Großen und Ganzen ist Deutsch keine schwierige Sprache.

(Overall, German isn’t a difficult language.)

24. Zusammenfassend kann man sagen, dass…  (In summary, it can be said that…)

Zusammenfassend kann man sagen, dass Sprachen beim Reisen sehr hilfreich sein können.

(In summary, it can be said that languages can be very helpful when traveling.)

Ok, let’s get a little deeper into the actual essays themselves. How do they compare to the essays that you’re probably used to writing?

• They have a similar structure to English essays. Remember how English essays have a beginning, middle and end? Good news: German essays contain those same parts. When you’re writing a German essay, you’ll want to include an opening paragraph with your argument, three supporting paragraphs that further your argument and a conclusion. German and English are often surprisingly similar, and essay structure is no exception.
• German essays are more to the point. Although German essays and English essays are structured similarly, German essays—just like German speakers—tend to be more blunt and to the point. You won’t need to dance around your conclusions or obfuscate in German: just say what you mean.
• German punctuation is different. Germans have different rules for punctuation than English speakers. For example, Germans introduce a direct quote with a colon instead of a comma. They use quotes instead of italics for the names of books, movies and newspapers. And they set off relative clauses beginning with dass (that) with a comma, unlike in American English. Understanding these differences between English and German punctuation will ensure you don’t give yourself away as a non-native speaker through punctuation marks alone!

Before you get started on your essay, make sure you know what type of essay you’re going to write. If it’s a school essay, be sure to read and understand the instructions.

Here are a few notes about the most common kinds of essays in German.

• An Erzählung  is a narrative essay that tells a story. Your teacher might give you some keywords or pictures and ask you to create a story around it. An Erlebniserzählung (“experience story”) is about a personal experience and can be written in the first person.
• An Erörterung is an argumentative essay, a writing piece meant to persuade someone to think the way you do. This writing genre requires you to investigate your topic well and provide evidence to prove your point.
• In a Nacherzählung you summarize and recount a book, a film or an article you have read, from an objective perspective. Depending on the essay instructions, you might be asked for your personal opinion in the conclusion.

Are you ready to start writing? Use these four strategies to wow your teachers and write the perfect German essay.

You should look at any new activity as an opportunity to learn and master new vocabulary . Instead of using the same words that you use in your everyday German speech, use this essay as an opportunity to introduce new words into your German lexicon.

Besides, incorporating academic words that help you craft and shape your argument can make your essay sound more professional and polished. So before you start writing, write down a list of the German words you’d like to incorporate in your essay.

As with everything else, you should look at the research portion of the essay-writing process as an opportunity to learn more about Germany—this time, about German culture, history , politics or travel .

Chances are if you’re writing your essay for a language-learning class, you’ll be assigned a topic pertaining to one of these aspects of German life, so use this as a chance to learn more about Deutschland.

For example, Deutsche Welle offers information and resources about German history. Other newspapers such as Berliner Zeitung and Frankfurter Allgemeine Zeitung offer another perspective on politics and daily life in Germany.

There’s nothing clunkier than an essay that doesn’t flow naturally from one point to the next. Besides, thinking about how your arguments and points interact with each other will help you organize your essay and make sure you get your point across. (Do they support each other? Counter each other? How exactly do they function to further your argument?)

Examples of transition words:

• Vorher (prior)
• zur gleichen Zeit (at the same time)
• dann (then)
• trotzdem (nevertheless)
• noch (still)

Writing an essay in English and then translating it into German often results in stilted, poorly formed sentences and unnatural constructions.

For example, remember that German word order is different from English. If you write “He didn’t read the book,” a one-to-one literal translation would be Er hat gelesen nicht das Buch . But the correct translation is actually  Er hat nicht das Buch gelesen. In this example, translating word for word leads to errors.

There’s another, less tangible reason why it’s not a good idea to write in English and translate to German. Sure, you could just remember that you need to change the word order when translating into German. But isn’t it better to adapt your brain so that German word order seems fluid and natural?

Learning to think and write off-the-cuff in German is an essential step towards fluency, and devising sentences in German, instead of sentences in translation, will help you learn to do that.

One good way to learn to think in a language is to hear it spoken in natural contexts. You can hear German spoken naturally in German language TV shows , movies and YouTube videos .

Listening to German spoken at a natural speed and native accent will help get you thinking in the language in real time. This will help get you to the point where you can come up with your own sentences in German, rather than thinking in English sentences first and then translating them in your head before you speak or write. That will greatly improve your speed and fluency when writing in German.

So, simply start writing the essay in German. Look up any words you’re not sure of and double-check any grammatical constructions that you’re not familiar with. After you finish writing, ask a German-speaking friend to look over the essay to make sure it sounds natural.

Now that we’ve explored strategies and phrases for writing top-notch German essays, let’s take a look at an example.

World War I doesn’t get as much coverage in the States as World War II (where it was more directly involved). But for Europe, World War I was a devastating example of the dangers of modern technological warfare and the horrors of violence.

Let’s take a look at an example opening paragraph and outline of an essay about the effect of World War I on German government and life.

Opening paragraph:

Der Erste Weltkrieg war ein totaler Krieg, der Deutschland völlig veränderte. Dieser Krieg hat 1914 angefangen, und 1918, als der Krieg zu Ende kam, waren die deutsche Gesellschaft, Regierung und Kultur nicht mehr erkennbar. Am Anfang hat der Erste Weltkrieg altväterliche Ideen und Systeme verstärkt. Am Ende hat dieser Krieg dagegen diese altväterlichen Dinge zerstört.

(The First World War was a total war that completely changed Germany. This war began in 1914 and in 1918, when the war came to an end, German society, government and culture were no longer recognizable. At the beginning, the First World War strengthened old-fashioned ideas and systems. However, by the end, this war destroyed these old-fashioned things.)

Notice that this opening paragraph is not very different at all from the first paragraph of an English essay. You can use the same structure you’ve always used to write your German essay, leaving you free to focus on grammar and vocabulary.

Notice also the use of phrases such as Am Anfang (at the beginning) and Dagegen (however). Words like these can help you make a point and counterpoint in your opening paragraph (or anywhere in your essay, for that matter).

I. Am Anfang (at the beginning):

– Dieser Krieg hat Deutschland vereint . (This war united Germany.) – Menschen hatten ein patriotisches Gefühl. (People had a patriotic feeling.) – Menschen dachten, dass der Krieg bald zu Ende kommen würde. (People thought that the war would soon come to an end.)

Notice that these points employ words like dachten (thought). Written German often relies on Präteritum , a form of the past tense that’s rarely used in spoken Deutsch. It’s often called “literary past tense” for this reason. Check out this guide to the Präteritum to include this tense in your essay.

II. Andrerseits (on the other hand):

– Bald gab es kein Essen mehr . (Soon there was no more food.) – Menschen wurden krank und desillusioniert . (People became sick and disillusioned.) – Es gab Proteste und Unruhen. (There was protest and unrest.)

Like in an English essay, your second and third paragraphs can include supporting points or counterpoints that contribute to the overall theme of your piece. The word Andrerseits (on the other hand) is an ideal transition word to show that you’re moving into another section of your essay.

Also notice that this essay will rely on vocabulary words that the average language learner might not have come across in his or her learning. After all, who learns the words for “disillusioned” and “unrest” in their intermediate German class? But don’t be daunted by the fact that your essay might include eclectic vocabulary. Instead, use this as an opportunity for more learning.

III. zum Schluss (in conclusion):

– Der Kaiser hat abgedankt . (The Emperor abdicated.) – Eine Republik wurde geboren. (A Republic was born.) – Die alten Werte waren weg. (The old values were gone.)

Once again, abgedankt (abdicated) is an example of the literary past tense (and an example of a word that you probably haven’t come across in your previous German studies!)

IV. Schließlich (finally)

– Der Erste Weltkrieg hat Deutschland verändert . (The First World War completely changed Germany.)

Again, like in an English essay, you should use this paragraph to summarize your main point.

Feeling a bit more confident about your next German essay now?

Just make a great essay plan, write down some new words and phrases that you want to include and off you go!

By sprinkling these bits of flair into your German essays, you’re sure to make your writing better and more effective.

Enjoy writing!

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GCSE German #003: Topics – Health (Gesundheit)

• September 28, 2015
• Deutsch , GCSE German , Resources

Happy Monday (again)! So last week there was no post due to my relocation back to Vienna, but I’m back this week and ready to go!

My plan for the next few weeks is to look at some of these GCSE topics a little more in depth – though they are, of course, quite broad. I’m hoping that I can bring together different resources that are out there on the internet that you can use to practise your German and prepare for your exams. Some of them may include vocabulary and grammar that aren’t as necessary for your exams, but they might have more practical real-life applications. As with anything in this series of posts, if you have any questions or any suggestions for anything you want to see – let me know! I’m happy to hear from you and help you if I can.

So, for this week, we’re going to talk about health!

Now, I am using the AQA topic list as a guide, because it’s quite comprehensive and I sat the AQA German GCSE myself, so I have a slightly better idea of how it works. However, there is a general crossover between all three exam boards, so this should be helpful for all of you.

I’m going to split this post into four parts: listening, reading, writing and speaking. Under each heading will be a few activities you can do to practise that skill. I would also urge you to begin working on your vocabulary now – I left links to the specifications (which have vocabulary lists) in the first post and to memrise courses where you can practise those words. You might not be on this topic yet, but start practising vocab for the one you are on; that way you’ll just be building on top of what you know, instead of cramming all in one go.

Leben in Deutschland – Gesundheit : This comes from the Goethe Institut and it’s a listening and reading exercise. You have a slideshow which involves a woman named Anne Geiger going to the doctor. You can listen to what she and the people around her say and read along with the text. There are also eight Übungen (exercises) which accompany this topic; they include comprehension questions, a crossword, putting sentences in order and reading an email.

BBC Bitesize – Healthy and Unhealthy Lifestyles [ foundation ] [ higher ]: These are quite old but useful revision tools, as they’re designed to help with GCSE exams. They’re very straightforward – you listen and answer the questions – and they give you the information to mark yourself right or wrong. There’s only the one exercise, but it’s very good practice to get in before your exam.

DW.com – Donnerstags kein Fleisch : This is an article (though you can also download and listen to an mp3/wma of it) about a town where every Thursday is ‘vegetarian day’. It is a little more advanced than would be expected of you at this level, but it talks about food and health, as well as being environmentally friendly (another one of your GCSE topics). There’s a glossary underneath the article (the article is ~300 words) and five multiple choice questions. The solutions don’t appear to be on the site, however, so if you’re not sure and want them checking, go to your teacher!

Deutsch Perfekt – Rauchverbot in der Schweiz : Deutsch Perfekt is actually a magazine with articles and features at different levels, to help you learn German. They also have a very comprehensive website, with articles and exercises you can use to practise. This article is rated at a ‘mittel’ difficulty – I think that makes it around an A2 level, which may be difficult, but I think you can probably read it. Again, some words are highlighted as being unknown, so you can hover over them to see their definitions. This article is shorter than the other one – ~160 words long – and there are no questions to answer. Plus, smoking and drinking are usually topics you have to touch upon when it comes to healthy and unhealthy lifestyles – and you’ll learn a little about Switzerland!

nthuleen.com – Krankheit und Gesundheit : This website has a multitude of worksheets (some of which you might see pop up in class!) which are really useful. This worksheet has a couple of vocabulary/reading exercises, but importantly, there’s a writing task at the bottom – Max doesn’t want to go to school, so you have to write a short dialogue, conversation or story about what happens. There’s an answer sheet here too , so you can check it against that – or, again, take it to your teacher.

Another good writing task for practice: write a short blog post or article about the advantages and disadvantages of a healthy lifestyle. Write seven to ten sentences (or 100-150 words). To get this checked, you can take it to your teacher, post it on lang-8 and wait for a friendly native speaker to correct it, or even post it in the comments here if you’d like! I’ll do my best to help you out.

It can be more difficult to find speaking activities, so what I’ve done is taken some questions from this website: Conversation Questions for the ESL/EFL Classroom . Try answering them with a friend (listen to each other and see if you hear any mistakes), or record yourself speaking and listen to it back. This can be a bit cringey at first, but no one else has to hear it – and it’s a much better way of catching yourself out.

Try answering some or all of the following questions. See if you can speak for ten seconds. Then twenty. Keep adding on time until you get to a minute. It might seem impossible at first, but if you build it up then you will get there.

• Denkst du, dass du einen gesunden Lebensstil hast?
• Was ist gesundes Essen?
• Ist Fettleibigkeit ( die – obesity ) ein großes Problem in deinem Land?
• Ist es wichtig zu trainieren? Trainierst du?
• Jedes Jahr beginnen ungefähr 200.000 junge Leute in Großbritannien zu rauchen. Wie denkst du darüber?

(If you want more health questions – but in English – then you can find those here .)

Everything Else

I realised I’ve been a bit remiss in giving you links to German dictionaries, though I guess you already know at least one. Still, my favourite is dict.cc, though dict.leo.org is a good alternative.

One of the websites I mentioned above, nthuleen.com , is one I’d forgotten about in my last post – but it has a lot of worksheets that you might find useful to use at home. Here’s another one which works on food vocabulary ; have a look through the site and see what else you can find.

Other advice: make note of the words you don’t know. When you’re reading, highlight and then come back to them later, especially if it’s a word you come across more than once. Check if it’s on the main vocabulary list; if it is, make a note to learn it and if it’s not, then definitely learn it because it might come in handy later, especially for your speaking/writing exam or coursework. When you’re writing, do the same – maybe skip the word at the time, but look it up later. Write down any necessary information about the word (its gender and plural form if it’s a noun, any irregular conjugation if it’s a verb, etc.). For speaking, try and talk around the term if you can’t remember it exactly, as this is a skill that will pay off. It’s difficult at first, but like all things, it becomes easier the more you do it.

This might sound like a lot, but remember: you don’t have to do it all at once! Take your time. Enjoy yourself. You might not like talking about smoking or food, but chances are there’s a part of this topic you are interested in – so see if you can find anything about that in German, too. Plus, the more you use materials like this alongside your school exercises, the more used you’ll get to German and the better you’ll become.

Good luck, and I’ll be back next week!

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• German health care: a...

German health care: a bit of Bismarck plus more science

• Related content
• Peer review
• Peter T Sawicki , institute director ,
• Hilda Bastian , head of health information department
• 1 German Institute for Quality and Efficiency in Health Care, Dillenburger Strasse 27, Cologne 51105, Germany
• Correspondence to: H Bastian hilda.bastian{at}iqwig.de
• Accepted 26 August 2008

Germany’s health system provides good access to care for all patients. But, as Peter Sawicki and Hilda Bastian explain, it is increasingly turning to science to determine what is good value

Germany was the first country to develop a national system to insure people against medical costs. It was in 1883 that one of the most conservative of politicians, Otto von Bismarck, laid down the first foundation slab for the modern European welfare state. Scientific and medical research was a pillar of Germany’s economic and industrial development strategy from that time as well. These policies and structures helped develop an advanced, highly medicalised, and technological healthcare system. In recent decades, a combination of wealth and strong social welfare infrastructure has insulated Germany from having to ask too many hard questions about the value of one of the world’s most expensive healthcare systems. This article looks at the challenges of maintaining the legacy of access to health care for all, a growing commitment to patient empowerment, and the changing role of evidence in western Europe’s most populous country.

Universal access to all necessary health care

The roots of Germany’s commitment to universal access to health care are deep. It was clear to Bismarck and his contemporaries that the only way to protect individuals from catastrophic health problems was if the whole community shouldered the risk. They could not have foreseen, though, just how expensive health care was going to become 125 years later. Back then, medical insurance was politically the easiest of the social security planks to achieve. 1

Fast forward to 2008, and the costs of statutory health insurance are now split roughly 50:50 between employers and employees, with the government paying for coverage of welfare recipients. Statutory insurance covers over 90% of the population. The remainder are covered by private insurance. Cost control in health has become one of the country’s most heated political issues. In 2007, the latest major reform proposals ignited doctors’ strikes and street protests by health insurance employees. 2 The doctors were concerned about additional bureaucratic requirements eating into their already limited time for patients and perceived threats to clinical freedom. Insurance employees feared job losses from restructuring and amalgamations. There were negotiations for legislative amendments right to the final hours of parliamentary debate.

It is not the insurance system itself that is so heavily contested. Germans definitely want their social health protection to continue, and with good reason. Comparative analysis has suggested that statutory health insurance systems such as those in Germany, France, and the Netherlands produce better responsiveness, equity, and life expectancy than taxation based systems, although at greater cost. 3 4 In Germany, most decisions about health policy and many key reimbursement decisions are made by the federal joint committee, which represents the providers (particularly doctors and hospitals), statutory insurers, and recently patients. 5 The ministry of health has only a legal oversight function. This keeps health policy in the hands of the health system rather than government, although the dispersal of power among competing stakeholders ensures constant dynamic negotiation. The Institute for Quality and Efficiency in Health Care (IQWiG), established in 2004, provides evidence assessments to support decisions (box).

German Institute for Quality and Efficiency in Health Care ( www.iqwig.de )

Evaluates evidence for national decision making on policy and reimbursement and for health information for the general public

It is established by legislation, but is independent of both government and the health service and funded through statutory health insurance

Professional, community, and industry representatives are involved in assessments, with public consultation at various stages

Products or interventions are assessed after they have already been introduced into the healthcare system

The institute provides recommendations based on evidence but decisions are taken by the federal joint committee and health ministry

The institute monitors published systematic reviews and health technology to identify developments of potential interest for patients and the general public

It is also developing methods for evaluating clinical practice guidelines and assessing the relation between costs and benefits

The institute differs from NICE in three main ways: it evaluates evidence but does not take the ensuing decision (which is usually the role of the federal joint committee); its remit in informing the general public is not limited to the areas of its evidence assessments; and it does not develop clinical practice guidelines

Medical care and costs

The law is clear on the expectations for German health care: “The insured are entitled to care when it is necessary to detect an illness, to heal, to protect against worsening of the condition or to relieve symptoms.” 6 The system privileges access: patients have traditionally had direct free choice of doctors and hospitals. Access to care is comparatively good (table 1 ⇓ ). 7 General practitioners do not act as gatekeepers to the system. However, some statutory insurers now offer financial incentives for patients to sign on exclusively with one doctor, including waiver of user charges for the patient and annual per capita payments for the doctor.

 Access to health care reported by sicker patients in three countries, 2005 7

• View inline

Germany has one of the highest per capita expenditures on health in the Organisation for Economic Cooperation and Development (OECD) (table 2 ⇓ ). 8 9 10 However, incomes for general practitioners and hospital based doctors are low considering that hospital workloads and general practitioners’ working hours are higher than in some comparable countries and increasing. 2 9 Germany has more privately practising specialists than general practitioners, and their average net income was around €160 000 (£124 000; $217 000) in 2003. 11 Reimbursement for primary care services has recently been increased.

 Health expenditure in selected OECD countries, 2005 8 9

German general medical practices lack practice managers so doctors spend an excessive amount of time on administration. 2 With some of the highest caseloads in Europe and no payment structure for longer consultations, German general practitioners spend less than eight minutes on average with a patient. 12 A comparison of several European countries found Germany had the shortest consultation times, and it was directly related to the high caseload. The German consultation is almost 30% shorter than the European average, and less than half the length of time available in the countries with the longest consultation times surveyed (Belgium and Switzerland). 12 German patients visit their doctors frequently but do not have enough time for real discussion. 12 The squeeze on time for direct patient care is a major source of frustration for patients and doctors and was a central issue in the recent doctors’ strikes. 2

Drug use and costs

Germany generally pays the highest prices for drugs in Europe, and it also has the most new drugs available. 13 14 Together with the size of the population (over 80 million), this makes Germany Europe’s largest spender on drugs. Most drugs are publicly reimbursed immediately after European regulatory approval—and at whatever price industry has set. Germans use more over the counter products than people in other European countries and the United States but fewer prescription drugs than some. 13 There is also heavy use of publicly reimbursed complementary medicines, including homoeopathy and herbal products.

Several measures have been introduced to try to contain drug costs, although it is too soon to judge the effect. And the bar on what constitutes proof of benefit is also being raised. IQWiG requires evidence of superiority based on outcomes relevant to patients. In 2007, the social legislative code was amended to allow insurance funds to set maximum drug prices and negotiate prices with industry. It also enables IQWiG to assess cost effectiveness. But after decades of almost boundless access to drugs, many people find it difficult to accept limits. A decision to limit the reimbursement of short acting insulin analogues because they were more expensive than regular insulin without evidence of superior benefit led to a protest outside the IQWiG building. And a finding that clopidogrel monotherapy for secondary prevention of vascular diseases had superior benefit for only one indication led to major industry pressure at the highest political levels in Germany. 15

Health status and quality of care

According to a European Union survey in 2006, Germans perceive their general health status to be roughly similar to that reported by people in France and the UK: 74% rate their health as good or very good. 16 Germany performs relatively well in the OECD’s indicators of quality of health care (table 3 ⇓ ). 17 18

 OECD healthcare quality indicators in selected countries 8 16

Patients are relatively satisfied with their choice of surgeon, but they report more problems with discharge planning than in several English speaking countries. 19 This reflects the historically rigid separation of responsibilities between hospitals and the community sector within the German healthcare system.

In 2005, Germans had a life expectancy just over the OECD average. 8 After the fall of the Berlin wall in 1990, Germany faced the challenges of integrating two large countries with very different healthcare and political systems and different lifestyles. Initially, life expectancy rates in the east worsened but then improved substantially. Although the gap between east and west has narrowed, it has not been eliminated. Addressing regional disparities remains an important priority.

Strengthening patients’ rights and knowledge

Germany has comparatively good patient advisory systems, although it has less public involvement at the societal decision making levels and does fewer patient surveys than the UK. 20 There are between 70 000 and 100 000 self help groups in Germany. 21 They attract considerable public funding, although there is concern that industry influence on these groups is increasing. 22

Major self management strategies have developed and flourished. Models for training and support for flexible self management of diabetes have been copied by other countries, including the UK, 23 and self management of drugs such as oral anticoagulants is also well established. Patient training programmes in several chronic diseases have been supported by the statutory health insurance.

In 2004, a parliamentary post of federal commissioner for patients’ issues was established as a critical element in Germany’s commitment to strengthening patients’ rights and autonomy. In 1999, a survey found that only one in four people were aware of key rights. In 2002, after a national patients’ charter was released, almost 43% of people surveyed had heard of it. 21 Rights at the end of life are one of the features of this charter, and the number of living wills subsequently increased in Germany: around 10% of adults have now deposited living wills. 24 The patients’ rights charter was further developed in 2005, 25 and now the possibility of legislation on patients’ rights is being discussed. Important gaps remain in Germany’s patients’ rights infrastructure, however. For example, there is no nationwide independent complaints mechanism for the health service.

German patients report similar levels of dissatisfaction and concern with communication with their doctors as do patients in English speaking countries, and many would like more information and a more active role in their health care. 7 21 One of IQWiG’s roles is to provide information to support personal evidence based decisions. The goal is to achieve a reasonably comprehensive evidence based health encyclopaedia by 2012. IQWiG’s health information is online in both German ( www.gesundheitsinformation.de ) and English ( www.informedhealthonline.org ), and it has been incorporated in the NHS Choices and NHS Direct websites. The French health authority also intends to translate some of the institute’s health information.

More evidence based system

Central to German reform is encouraging more rational healthcare choices. That applies both to national funding decisions and to the individual choices made by patients and doctors. At a national level, this means becoming more deliberative about which interventions are truly necessary—and how much they are worth. Inferior treatments can now be rejected and the scope for negotiating prices for both superior and non-superior treatments has been expanded. For individuals, a key focus is providing patients with the knowledge needed to make informed personal choices. For each of these strategies, the science of evaluating health care provides an essential knowledge base and ground rules, and the term “evidence based medicine” is a prominent new feature in the social legislative code. The establishment of IQWiG was pivotal here. 26 27

What needs to happen

Ultimately, however, this is unlikely to be enough. The current system does not require all drugs and technologies to be assessed for clinical superiority and value before they enter use. Germany is constantly, in effect, trying to close the stable door after the horse has bolted. The health and social price for that is high. Some industry and other interest groups inevitably put considerable effort into fanning patients’ and doctors’ fears of cost cutting and causing enough pressure to prevent loss of access to available treatments. In our view this social unease is unnecessary. Given Germany’s economic strength, the country can afford high quality universal health care. Artificially capping expenditure is not an urgent necessity.

Germany cannot, however, continue indefinitely paying higher prices for new treatments that do not offer better outcomes. At the same time, there remains too little appreciation of the fact that every new technology does not necessarily represent progress, and interventions of inferior effectiveness expose patients to the risk of inferior outcomes. Two key requirements to change this are more independent critical evaluation and better public understanding of the realities of what achieves good and poor health outcomes.

Importantly, Germany nurtured a system where public hospitals should serve as centres of excellence where innovations can be carefully shepherded into practice and monitored. This remains an important approach to ensuring continuing innovation. However, it needs to be accompanied by a much greater investment in clinical research and monitoring of outcomes. Rushing high priced products into the market on the basis of surrogate outcomes is commercially profitable but can result in significant harm to patients. More independent evaluation of healthcare interventions is needed that focuses on what patients and clinicians care about and need to know.

For knowledge to translate into better informed decisions, the evidence has to be readily accessible to patients as well as doctors and other health professionals. Just as vitally, they need to have the time to consider it and discuss it with each other. Germany has developed a healthcare system that can provide universal access, but the challenges now are to optimise health outcomes and ensure the system’s sustainability. This will mean placing a higher premium on clinicians’ time and knowledge. A lot of science and considerable political commitment will be necessary to sustain Bismarck’s legacy of social protection for health care.

Cite this as: BMJ 2008;337:a1997

• Analysis, doi:10.1136/bmj.39451.406123.AD

Countries across Europe have common health challenges but many different ways of tackling them. This article is part of an occasional series that looks at what we can learn from each other.

Contributors and sources: PTS is a professor and specialist in internal medicine. HB is a health information editor with a background in health consumer advocacy. The authors’ views are derived from an analysis of recent survey data and from their experience inside and outside of the German Institute for Quality and Efficiency in Health Care. HB undertook the analysis of survey data. Both authors determined the content and conclusions, and participated in the drafting of the manuscript. PTS is the guarantor.

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

We welcome contributions to this series. Please send your suggestions to Tessa Richards ( trichards{at}bmj.com ).

• ↵ Hennock EP. The origin of the welfare state in England and Germany, 1850-1914: social policies compared . Cambridge: Cambridge University Press, 2007 .
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• ↵ Gemeinsame Bundesausschuss (Federal Joint Committee). The German health care system and the Federal Joint Committee . Bonn: GBA, 2007 . www.g-ba.de/institution/sys/English .
• ↵ Bundesministerium der Justiz. Sozialgesetzbuch (SGB) Fünftes Buch (V)—Gesetzliche Krankenversicherung . [Social law, 5th book, statutory health insurances] 2008 . http://bundesrecht.juris.de/sgb_5 .
• ↵ Schoen C, Osborn R, Huynh PT, Doty M, Zapert K, Peugh J, et al. Taking the pulse of health care systems: experiences of patients with health problems in six countries. Health Aff (Millwood) 2005 Jul-Dec (suppl web exclusives):w5-509-25.
• ↵ Organisation for Economic Cooperation and Development. OECD health data 2007 . Paris: OECD, 2007 .
• ↵ Bramley-Harker E, Barham L. Comparing physicians’ earnings: current knowledge and challenges: a final report for the Department of Health . London: NERA Economic Consulting, 2004 . www.nera.com/image/Report_Physician_Earnings_7.2005.pdf .
• ↵ Organisation for Economic Cooperation and Development. Science and technology scoreboard 2007: health-related R&D . http://caliban.sourceoecd.org/vl=10224931/cl=27/nw=1/rpsv/sti2007/a-8.htm .
• ↵ Hauschild W, Klose A. [Cost structures for medical and dental practices 2003.] Berlin: Statistisches Bundesamt, 2006.
• ↵ Deveugele M, Derese A, van den Brink-Muinen A, Bensing J, de Maeseneer J. Consultation length in general practice: cross sectional study in six European countries. BMJ 2002 ; 325 : 472 . OpenUrl Abstract / FREE Full Text
• ↵ Danzon PM, Furukawa MF. International prices and availability of pharmaceuticals in 2005. Health Aff 2008 ; 27 : 221 -33. OpenUrl Abstract / FREE Full Text
• ↵ Garattini L, Motterlini N, Cornago D. Prices and distribution margins of in-patent drugs in pharmacy: a comparison in seven European countries. Health Policy 2008 ; 85 : 305 -13. OpenUrl CrossRef PubMed Web of Science
• ↵ Gemeinsamer Bundesausschuss. [Federal joint committee retains the prescribing restriction for clopidogrel under statutory health insurance.] Press release, 22 February 2008.
• ↵ European Commission. Health in the European Union. Special Eurobarometer 272e/Wave 66.2 . 2007 . http://ec.europa.eu/health/ph_publication/eb_health_en.pdf .
• ↵ OECD. Health care quality indicators project 2006: data collection update report . www.oecd.org/dataoecd/57/22/39447928.pdf .
• ↵ Veit C, Bauer J, Döbler K, Eckert O, Fischer B, Woldenga C. [BQS quality report 2006.] Düsseldorf: Bundesgeschäftsstelle Qualitätssicherung, 2007. www.bqs-qualitaetsreport.de/2006/ergebnisse/leistungsbereiche/hueft_femur/ergebnisse/index_html .
• ↵ Sawicki PT. [Quality of health care in Germany: a six-country comparison.] Med Klin 2005 ; 100 : 755 -68. OpenUrl CrossRef Web of Science
• ↵ Forster R, Kranich C. [Patient and public involvement in health care—a comparison between recent English and German policies.] Gesundheitswesen 2007 ; 69 : 98 -104. OpenUrl CrossRef PubMed Web of Science
• ↵ Dierks M-L, Seidel G, Schwartz FW, Horch K. [Public and patient orientation in the health care system.] Issue 32 Gesundheitsberichterstattung des Bundes. Berlin: Robert Koch Institute, 2006.
• ↵ Forum Gesundheitspolitik. [Every fourth self-help group is sponsored by drug companies.] www.forum-gesundheitspolitik.de/artikel/artikel.pl?artikel=0555 .
• ↵ DAFNE Study Group. Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial. BMJ 2002 ; 325 : 746 . OpenUrl Abstract / FREE Full Text
• ↵ Lang FR, Wagner GG. [Patient living wills in Germany: conditions for their increase and reasons for refusal.] Dtsch Med Wochenschr 2007 ; 132 : 2558 -62. OpenUrl CrossRef PubMed
• ↵ Ministry for Health and Social Insurance, Ministry for Justice. [Patient rights in Germany: Guidelines for patients and doctors.] www.die-gesundheitsreform.de/gesundheitssystem/publikationen/pdf/broschuere_patientenrechte_deutschland.pdf .
• ↵ German Institute for Quality and Efficiency in Health Care. The institute . www.iqwig.de/about-us.21.en.html .
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German Healthy lifestyle

Eine normale Mahlzeit, die ich für das Mittagessen haben würde wäre ein Hähnchen-Sandwich mit Mayonnaise und einen Kräutertee.Letzte Woche habe ich Haferflocken gegessen und ich mochte es nicht, denn es war fad. ,aber es schmeckt immer fad. Ich glaube, ich bin gesund, weil ich einen Ernährungs Frühstück habe und ich komme nie mit dem Bus zur Schule, aber immer zu Fuß. Wenn ich ein Fahrrad hätte würde ich das Fahrrad zur Schule, aber meine Mutter sagte nein, weil sie denkt, ein Fahrrad ist eine Verschwendung von Geld. Ich bin damit nicht einverstanden, weil Fahrradfahren einfacher ist als zu Fuß ich gehen und eine gute Möglichkeit, gesund zu bleiben.

Um gesund zu bleiben, sollte man frühstücken, weil das Frühstück die wichtigste Mahlzeit des Tages ist. Man sollte versuchen, fünf Portionen Obst und Gemüse pro Tag zu essen. Ein Teil ist 80 g Obst und Gemüse. Dies ist in etwa gleich ein Apfel, Orange, Banane oder ähnlicher Größe Obst oder zwei Suppenlöffel von gekochtem Gemüse wie Brokkoli oder Karotten.

Das ist sehr gut für die Haut und macht sie glatt wie meine. Ich wasche mein Gesicht jeden Tag und es ist sauber und sieht nett aus im Gegensatz zu Menschen, die rauchen, weil sie schrecklich riechen. Ich rauche nicht, und ich werde nie rauchen,weil rauchen die häufigste ursache von Krebs weltweit ist. Im Vereinigten Königreich, ist Rauchen allein für ein Viertel der Todesfälle verantwortlich durch Krebs sterben fünf Mal mehr Menschen als durch Verkehrsunfälle und Mord.

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Mein Großvater hat Zigaretten geraucht und ich habe es gehasst,weil,wenn ich das Haus verlassen habe stanken stinken meine Haare und Kleidung nach Zigarretten und es war der schlimmste Geruch in der Welt. Mein Großvater ist krank geworden, weil er Zigarretten geraucht hatte.

Ich treibe im Gegensatz zu meinem Großvater Sport und in meiner Meinung fördert Sport die Gesundheit. Letztes Jahr machte ich Kung-Fu und ich war sehr gut und sehr muskulös, aber jetzt spiele ich Fußball, um schneller zu sein damit ich professionell spielen bann. Sport ist mir Wichtig und wenn ich älter bin, hoffe ich, dass ich so gut wie Wayne Rooney sein werde. Wie viele Stunden Sport treiben Sie pro Woche?

A normal meal I would have for lunch would be a chicken sandwich with mayonnaise and a herbal tea. Last week I ate oatmeal and I did not like it because it was bland . I think I 'm healthy because I have a nutritional breakfast and I never get there by bus to school, but always on foot. If I had a bike I would bike to school , but my mother said no, because she thinks a bike is a waste of money . I do not agree , because cycling is easier than walking , I go and a great way to stay healthy .

To stay healthy , you should eat breakfast , because breakfast is the most important meal of the day. One should try five servings of fruits and vegetables a day to eat . A portion is 80 g fruit and vegetables. This is roughly equal to an apple, orange, banana or similar size fruit or two soup spoons of cooked vegetables such as broccoli or carrots.

This is very good for the skin and makes it smooth as mine. I wash my face every day and it is clean and looks nice as opposed to people who smoke because they smell awful . I do not smoke , and I will never smoke because smoking is the most common cause of cancer worldwide. In the UK , smoking alone is responsible for a quarter of deaths from cancer die five times more people than traffic accidents and murder.

My grandfather has smoked cigarettes and I hated it because when I left the house smelled my hair and clothes stink after cigarrettes and it was the worst smell in the world. My grandfather became ill because he had smoked cigarettes .

I drive unlike my grandfather sport and in my opinion sports promotes health . Last year I made kung fu and I was very good and very muscular , but now I play football to be faster for me to spell play professionally. Sport is important to me and when I'm older , I hope I 'll be as good as Wayne Rooney. How many hours of sports are you doing per week?

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• Word Count 723
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• Subject Modern Foreign Languages
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Experiencing History Holocaust Sources in Context

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Everyday Life: Roles, Motives, and Choices During the Holocaust

Public health under the third reich.

These sources explore public health polices in Nazi Germany and their impacts during World War II and the Holocaust. Featuring films, photographs, and other sources, this collection shows how the regime built upon common concepts of public health to support Nazi racial ideology and the goals of conquest and expansion.

Nazi views on public health developed within the context of German cultural traditions and medical science in the early 20th century. Many of the regime's public health priorities—such as eugenics , group exercise, and warnings against alcohol and tobacco—were first popularized during the years of the Weimar Republic . For example, in the 1930 film, “Born out of Necessity,”  young Germans are urged to fight the negative health effects of life in modern cities by exercising together and engaging in wholesome social activities instead of drinking and smoking. These themes were later reflected in public health policies after the Nazi rise to power in 1933.

Nazi public health officials adopted many of these traditions and ideas, but the Nazi regime’s public health policies were concerned solely with promoting the health of so-called “Aryan”  Germans. According to Nazi ideology, every member of the so-called " Volksgemeinschaft " (German racial community) was like a single cell in the larger national body. Each individual had a duty to stay healthy and strong so that the German nation could conquer other peoples and colonize their lands. These theories about individual health and national strength were influential throughout Europe and the United States in the early 20th century. However, Nazi Germany's policies were much more extreme than those of any other nation.

To help realize the regime’s goals, Nazi public health initiatives focused on increasing the size and health of the “Aryan” population. For example, the SS created the Lebensborn program in late 1935 in an attempt to raise the German birthrate. A brochure for the Lebensborn program explains that only pregnant women of “good health, genetic health, and Aryan descent” would be considered for admission to the program’s maternity homes. 1 Nazi theories of eugenics taught that those born with mental or physical disabilities weakened the collective genetic health and strength of the Volksgemeinschaft and were "life unworthy of life." 2 The propaganda pamphlet “But Who Are You?” provides instructions for creating detailed ancestral charts in order to identify any  threats to the “hereditary health” of the German nation. Health officials even urged German citizens to report sexual partners suspected of having a sexually transmitted disease, as shown in the 1938 propaganda poster, “Sexually Transmitted Disease Is an Obstacle to Marriage.” 3

The Nazi regime urged Germans to adopt healthy lifestyles and personal habits. Like Weimar-era public health campaigns, Nazi health programs pushed the idea of a wholesome and “natural” lifestyle as a remedy for many of the health concerns in modern society. Nazi public health campaigns often promoted the importance of fresh air and nutritious foods, as shown in the 1941 Nazi propaganda film, “The English Disease.” A 1939 newspaper article titled “Nazis Hit Alcohol, Tobacco” records Nazi health leaders’ declarations that rejecting tobacco and alcohol in favor of a “wholesome life” was the “national duty” of all German youth. 4

Nazi public health propaganda promoted a return to “natural” living, but Nazi health officials also embraced modern medical innovations to prevent and treat diseases in the so-called “Aryan” population. For example, the Nazi regime organized mass X-ray screenings for cancer, tuberculosis, and other illnesses. Nazi propaganda urged Germans to trust the advice of medical doctors over the "hocus pocus" given by unqualified quacks offering miracle cures, as seen in the 1941 propaganda film on cancer treatment,  "One in Eight." 5

Exercise and physical fitness were among the most important elements of the Nazi regime’s approach to public health. Nazi health officials called for every member of the so-called “Aryan” community to do regular physical exercises. Focusing particular attention on developing the health and strength of German youth, the Nazi regime embraced popular German pastimes like hiking and gymnastics. Nazi youth groups organized many outdoor group exercises intended to build a sense of camaraderie, and teenage boys in the Hitler Youth often engaged in competitive athletic games and military-style exercises to prepare them to become strong soldiers. On the other hand, Nazi ideology taught that young German women should do graceful exercises designed to help them become strong healthy mothers—as shown in the 1937 propaganda film, “Healthy Woman - Healthy Nation.” The regime also organized many athletic activities under the recreational “Strength through Joy” program. A 1937 photograph of a “Strength through Joy” event  shows the popularity of these public exercise programs. 

Campaigns and activities to promote physical fitness in Nazi Germany were designed exclusively for members of the so-called Volksgemeinschaft.  Jews, Roma and Sinti , and other so-called "non-Aryans" were gradually excluded from public spaces that hosted these events. Exercise was even used to persecute those targeted by the Nazi regime. German soldiers and concentration camp guards often used forced exercise as a form of public humiliation, physical abuse, or punishment. Taken sometime after the German invasion of the Soviet Union in June 1941 , a photograph of Soviet Prisoners of War forced to exercise shows how German guards used physical exercises to abuse their prisoners in violation of international law. 

Nazi persecution and the beginning of World War II affected the health of German citizens as well as the health of Jews, Roma and Sinti, and all those living under German occupation. The so-called “Aryanization” of the German medical profession meant that qualified Jewish health professionals no longer could provide medical care to their so-called “Aryan” patients. Like Dr. Erwin Schattner , many Jewish physicians were forced to close their practices on short notice after the Nazi Party took control of the state. Less qualified non-Jewish doctors often replaced Jewish physicians like Schattner, and the quality of medical care in Germany declined as the Nazi regime lowered academic standards for ideologically acceptable “Aryan” medical students.

The outbreak of World War II led to greater Nazi persecution of targeted groups and the application of drastic public health measures. The war created conditions that led directly to epidemics of contagious diseases such as typhus. Nazi propagandists and public health officials blamed Jews, Roma and Sinti, Slavic peoples, and other groups for causing such outbreaks. For example, an antisemitic Nazi propaganda poster made in 1941 for public display in German-occupied Poland asserts that “Jews Are Lice: They Cause Typhus.” German public health officials blamed Polish Jews for an outbreak of typhus in occupied Warsaw and urged authorities to construct a sealed ghetto, which cut off food supplies and caused massive starvation. As this 1941 photograph demonstrates , when typhus was discovered within the ghetto, German authorities imposed harsh quarantine measures. This oral history with Avraham Tory describes how Jewish medical providers in the Kovno ghetto were forced to treat typhus patients in secret after German police and Lithuanian collaborators burned a hospital to the ground with its staff and patients inside. 

Nazi ideology taught that the health and “purity” of the German national body must be protected at all costs. The priorities of public health under Nazi rule reflected and supported Nazi racial ideology, theories of eugenics, and the regime’s goal of conquest. Nazi public health campaigns were designed to improve the collective health of the German Volksgemeinschaft at the expense of other populations, but Nazi policies had negative impacts on the health of the so-called "Aryan" population as well.

For more on the Lebensborn program, see the Experiencing History item, Request to Replace Nurse Anna Hölzer .

For more on eugenics, see the United States Holocaust Memorial Museum’s online exhibition, "Deadly Medicine: Creating the Master Race." To learn more about the Nazi persecution and murder of people with disabilities, see Suzanne E. Evans, Forgotten Crimes: The Holocaust and People with Disabilities (Chicago: Ivan R. Dee, 2004).

The Nazi regime’s attempts to control sexual behavior and stop the spread of sexually transmitted diseases did not succeed, and public health officials became concerned about rising rates of gonorrhea. For more on sexually transmitted diseases in Nazi Germany, see Jeffrey Cocks, "Sick Heil: Self and Illness in Nazi Germany," Osiris, Vol. 22: The Self as Project: Politics and the Human Sciences (2007): 93–115. 

To learn more about alcohol and tobacco in Nazi Germany, see Jonathan Lewy, "A Sober Reich? Alcohol and Tobacco Use in Nazi Germany," Substance Use and Misuse 41, no. 8 (July 2009): 1179-95; and Edward B. Westermann, Drunk on Genocide: Alcohol and Mass Murder in Nazi Germany (Ithaca, NY: Cornell University Press, 2021). 

For more on Nazi public health policies regarding X-ray screenings and cancer treatments, see Robert N. Proctor, The Nazi War on Cancer (Princeton: Princeton University Press, 1999).

All 16 Items in the Public Health under the Third Reich Collection

Police Order on Tuberculosis X-Rays

tags: bureaucracy health & hygiene law enforcement science & medicine

type: Poster

Photograph of Prisoners Forced to Exercise

tags: group violence health & hygiene humiliation Red Army

type: Photograph

Propaganda Poster: “Jews Are Lice: They Cause Typhus”

tags: antisemitism fear & intimidation ghettos health & hygiene propaganda

Photo of Quarantined Building in the Warsaw Ghetto

tags: food & hunger health & hygiene propaganda science & medicine

"Healthy Woman - Healthy Nation"

tags: children & youth family gender health & hygiene propaganda women's experiences

type: Newsreel

Hitler Youth Training Film

tags: children & youth German military health & hygiene leisure & recreation

type: Raw Footage

"The English Disease"

tags: children & youth eugenics family food & hunger health & hygiene science & medicine

Oral History with Avraham Tory

tags: fear & intimidation ghettos health & hygiene refugees & immigration

type: Interview

"But Who Are You?"

tags: eugenics family health & hygiene propaganda science & medicine

type: Pamphlet

Brochure for the Lebensborn Program

tags: children & youth eugenics family science & medicine sex women's experiences

"Born Out of Necessity"

tags: children & youth health & hygiene leisure & recreation science & medicine

type: Documentary

Photograph of "Strength through Joy” Event at Strandbad Wannsee

tags: children & youth community health & hygiene leisure & recreation

"Sexually Transmitted Disease Is an Obstacle to Marriage"

tags: family health & hygiene propaganda science & medicine sex

"Nazis Hit Alcohol, Tobacco"

tags: children & youth health & hygiene propaganda

type: Newspaper Article

"One in Eight"

tags: health & hygiene propaganda science & medicine

Photograph of a "Strength through Joy" Car

tags: belongings community leisure & recreation propaganda

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Public Health – German Health Care

The health system in Germany comprises public and private institutions and individuals. In comparison with other countries, Germany has an unusually large number of doctors, specialists, therapists, dentists, social workers, medical staff to take care of patients as well as there are sufficient hospital beds. In addition, this also includes employees of other medical specialties and pharmacies with their staff. It is worth noting that approximately one in ten workers (4.2 million out of 80 million inhabitants) is involved in the health sector (Altenstetter, 2003). Moreover, the health care system represents the state (federation, land and communes) and provides medical insurance, accident insurance, care and pension insurance, union health funds. Furthermore, it handles employers, workers, and, last but not least, patients that are partially represented by patients’ associations and private health organizations.

Private enterprises, except for public clinics, offer medical services. In general, “free professions” such as doctors and pharmacists and large private enterprises (for example, pharmaceutical or medical-technical industry) dominate the health sector. Apparently, state plays a secondary role in the provision of medical services in the form of departments of health, public hospitals and university clinics. This paper determines general principles of health care and health insurance in Germany and reviews recent reforms.

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Description of the Country

The Federal Republic of Germany is located in the center of Europe. It is a democratic country open to the outside world with a long tradition. Germany has one of the strongest economies in the world and offers powerful innovations in terms of the scientific landscape. At the same time, the country is characterized by creative economy and the lively cultural life. Germany has 82 million people, and about 15 million of them have a migrant background, namely about 7 million people are foreigners, while 8 million individuals have German citizenship. Apparently, a plurality of lifestyles and a variety of ethnic and cultural nuances define the society. Despite changes in society, family remains the most important social unit. Most of residents have a good education, high standard of living and adequate opportunities for the development of personal life (Knox, 2009).

Germany is a land of ideas. It is worth mentioning that central importance is given to education and science, research and development. In Germany, there are about 370 universities for foreign students. Hereby, Germany (after the US and the UK) is the most attractive country for studying. Among European countries, Germany has the highest number of patent applications on a global scale. Therefore, considering that German citizens have a high level of lifestyle, they expect premium health care from the country (Moeller, Breinlinger-O’Reilly, & Elser, 2000).

Overview of Health Care

After reunification in 1991, Germany’s general clinics were closed and transformed into doctors’ offices. Nowadays, public health authorities play no role in the health sector with the exception of disasters and catastrophes. In fact, all university hospitals (clinics) with inpatient treatment remained in the hands of the state. To receive financing, German hospitals sign contracts with insurance companies as well as receive government subsidies from tax revenues. Apparently, numerous legislative reforms in the field of public health were trying to prevent the looming threat of double financing of costly infrastructure (for example, purchase of medical equipment). There were also attempts to unite academic and complementary medicine known in Germany as a new concept of integrative medicine (Moeller, Breinlinger-O’Reilly, & Elser, 2000).

Medical care can be divided into three types. Thus, primary medical and sanitary health care so-called “family medicine” is supported by doctors’ offices, clinics, and other outpatient facilities. In fact, about 90 percent of acute and chronic diseases are treated using this cost-effective and comprehensive system. Secondary health care that is so-called specialized medical services are provided by medical specialists in all fields of medicine who work with patients in the direction of physiotherapy. Apparently, a specialist performs outpatient or inpatient care in a hospital or clinic. In general, this sector of health care includes first aid, intensive care, operating rooms, laboratories, diagnostic radiology, and physiotherapy. With regard to tertiary health care, it is provided in specialized hospitals, clinics, and centers. They provide regions and usually a few cities with particularly complex and expensive services in institutions that handle accidents and disasters, cancer centers, transplantation centers and neonatology (Knox, 2009).

In order to become a doctor in Germany, a person must have higher education in the field of medicine. Enrollment in universities in this specialty program is highly competitive because the position of a doctor is considered to be highly prestigious. Talking about medical training, it covers pre-clinical studies and practical application (Porter & Guth, 2012). Students must complete five years of studying which includes two years of general science, three years of applied science and final year of clinical practice. Furthermore, future specialists must complete first aid training and have three month of nursing experience and four months of internship at the clinic (Knox, 2009).

The Principles of Health Insurance

Social health insurance is available to persons whose annual income does not reach 40 thousand euro. Apparently, this type of insurance provides the diagnosis and prevention of diseases as well as the statutory amount of outpatient and inpatient treatment, provision of medicines and aids, benefits in connection with a temporary disability, termination of pregnancy, and maternity. Insurance contributions provide care for the employees and non-working family members. The fee is dependent on the earnings paid by both employers and the insured themselves. The value of the contribution is not dependent on the number of children within the family (Porter & Guth, 2012).

Private (voluntary) health insurance applies to individuals whose annual income exceeds 40 thousand euro. The risk is calculated for each insured person, taking into account the premium (considering age, state of health and the amount of the desired medical services). In fact, such insured person has the right to choose the time for planned hospitalization, by whom they prefer to be treated taking into consideration doctor’s category (the head of the department or the chief doctor) and the accommodations at the hospital. With private insurance, in comparison to the social where medical services are covered by health insurance, the patient pays for medical care personally and then pays the insurance company’s expenses. In general, it reimburses 70-90% of the costs (Altenstetter, 2003). Repayment is usually made by reducing the fee when renewing the contract. Talking about private insurance, it exists in two forms, namely full and partial. The government manages the system of compulsory insurance of public fund, and since the year 1993, each holder of compulsory insurance is free to choose whether they want to change the annual health insurance fund. Due to increasing competition, the number of such funds has declined significantly, especially over the past few years. Funds can be divided into such following categories as 17 local health insurance funds, 10 trade union funds, 229 sector funds, 19 health insurance funds for employees of large companies, 10 agricultural funds, 1 Maritime Health Insurance Fund, and 1 mining fund (Porter & Guth, 2012).

Comparison of German and the US Health Care

The United States surpasses Germany grounded on the level of modern technology equipment (Shi & Singh, 2013). There are four times more devices for magnetic resonance imaging per million people in the US than in Germany, and the former has twice more CT scanners. The situation would be even worse if Germany did not have a small sector of private health insurance. Even though the share and account of private insurance constitute only a small percentage of total health spending, it exerts pressure on the health insurance companies, forcing them to expand the range and improve the quality of services. At one time, computer tomography was extremely rare so that patients were given access to it only in exceptional cases and after a long wait. Due to this competition, the government has allocated funds for the purchase of additional scanners (Porter & Guth, 2012). Therefore, German medical equipment cannot compete with the one in the US, but in comparison to the rest of the Europe, Germany is one of the leaders.

In comparison with the US health care, Germany shows much more independence. German insurance experiences the smallest amount of control from the state and sometimes, even none. Health care system in the United States is largely dependent on and suffers from regional and local regulations (Johnson & Stoskopf, 2009). Therefore, the US health care system should try to manage its medical care without government’s supervision.

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Current Reforms in German Health Care

Currently, there are three pending reforms in German health care. The first one involves changing the two tariffs for calculating the cost of medical services. Thus, one concerns private insurance, and another one relates to mandatory insurance. The state suggests that hospitals should impose one tariff on both types of insurance, which will greatly affect both sectors. It is worth saying that private insurance companies oppose this reform. The second one is similar and is proposed as an alternative to the first one by the private insurance companies. In calculating the cost of the services, German clinics used the so-called base rate settlement that is unique for each of the clinics. Therefore, this ratio reflects the cost of maintaining the infrastructure of clinical and other institutions that are on the balance of the clinic (it may be the university structure). Hereby, this factor can affect state clinics, which will allow them to hire more advanced staff and better equipment. In this case, the state is against this reform because it will have to invest more money in the public health care. Third reform involves medical specialists. Due to the fact that German doctors are very independent in their work, all of them are members of self-governing professional associations. In fact, these associations solve most of the issues of employment and training of doctors. Apparently, this is the reason why German doctors have more freedom and mobility when choosing their place of work. Moreover, the same high-class specialists can study at several universities and work in several clinics. Thus, the Federal Republic of Germany created the organizational prerequisites for a more personalized medicine (Knox, 2009). The reason doctors oppose this reform is that it will reduce their opportunities for employment and will decrease their level of income.

German health care has a high level of prestige because every tenth citizen is employed in this sector. In fact, only best specialists can become doctors, which creates competition and thorough selection of candidates. Considering that wages of medical personnel are very high, citizens can expect premium health care. Insurance companies and state keep in mind that German population is diverse and demands different types of medical care, which is why this sector is fitting to representatives of all communities. Germany has the highest level of technologies in its medical facilities in case patients may require it.

German health care continues to develop, and what is considered an innovation today, tomorrow will be obsolete, which is not necessarily a good thing for the economy. Nevertheless, in terms of research, Germany surpasses many countries. If the country will be changing politically and socially, it has all advantages to be a leader in the international medical arena. However, experts believe that the German health care system will be discussed in political forums at various levels for a long time because costs continue to rise and the number of patients who are able to afford expensive insurance continues to drop. The population is aging, and it threatens the principle of social solidarity in relation to health care.

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• v.8(Suppl 3); 2023 Jun
• PMC10278374

Climate change and public health in Germany – An introduction to the German status report on climate change and health 2023

Elke hertig.

1 University of Augsburg, Faculty of Medicine Augsburg, Germany

Iris Hunger

2 Robert Koch Institute Centre for International Health Protection, Berlin, Germany

Irena Kaspar-Ott

Andreas matzarakis.

3 German Meteorological Service Research Centre Human Biometeorology, Freiburg, Germany

Hildegard Niemann

4 Robert Koch Institute, Department of Epidemiology and Health Monitoring Berlin, Germany

Lea Schulte-Droesch

5 Federal Agency for Nature Conservation Division I 2.2 - Nature Conservation, Society and Social Issues, Bonn, Germany

6 Centre for Planetary Health Policy, Berlin

Global warming of 1.5°C and even 2°C is likely to be exceeded during the 21 st century. Climate change poses a worldwide threat and has direct and indirect effects on infectious diseases, on non-communicable diseases and on mental health. Not all people are equally able to protect themselves against the impacts of climate change; particularly populations that are vulnerable due to individual factors (children, older persons, those immunocompromised or with pre-existing conditions), social factors (the socially disadvantaged), or living and working conditions (e. g. people who work outdoors) are subject to an increased risk. Concepts such as One Health or Planetary Health provide a framework to frame both climate change itself and adaptation strategies or sets of actions for environmental human and animal health. Knowledge of climate change impacts has grown in recent years, and mitigation and adaptation strategies have been developed.

1. Preamble to the Status Report on Climate Change and Health 2023

Climate change poses one of the greatest threats to many people worldwide and has direct and indirect effects on communicable and non-communicable diseases. In view of the major health challenges, the German Federal Ministry of Health (BMG) is funding the project ‘Climate Change and Health – Status Report/Update with Advisory Board: Content, Communication, Working Methods’ (KlimGesundAkt), which is coordinated at the Robert Koch Institute (RKI, Germany’s national public health institute) and aims to update the 2010 Status Report on Climate Change and Health with a focus on Germany [ 1 ]. This update differs from the previous report in two ways:

(1) in the presence of an interdisciplinary and cross-institutional advisory board, which accompanies the entire planning and publication process of the updated status report,

(2) in the downstream target group-oriented communication and condensation of the results in the form of intuitive communication tools, including the formulation of recommendations for action.

The steps of this participatory and transparent process, which involved government authorities, university institutions and civil society, are outlined here.

The task of the interdisciplinary and cross-institutional advisory board was to deliberate on the report’s structure, scope and thematic focus. As a result, less space has been devoted to the causes of climate change than in the 2010 report, whereas other areas such as mental health and social inequality have been expanded or newly included. The coordination process took place in close cooperation with the internal RKI working group ‘Climate Change and Health’, which is independent of the project. This group brings together the RKI's knowledge of topics such as waterborne infections, heat-related mortality, vector-associated diseases, climate-related health behaviour, mental health surveillance and allergies, which is spread across various organisational units.

The status report will be published as a collection of articles in the Journal of Health Monitoring's Climate Change and Health series in three journal issues ( Table 1 ). This reflects contemporary scientific publication practices and provides greater availability of the results to the public health community. Primary addressees are the interested professional public as well as decision-makers with a remit in public health. Since the Journal of Health Monitoring is published in German and English, and the English edition is archived at PubMed Central and accessible via PubMed search, international visibility is also ensured.

Overview of all articles in three Special Issues in the Journal of Health Monitoring's Climate Change and Health series

Authors with the desired expertise were identified on the basis of the topics to be addressed. A dual role for members of the advisory board as authors was encouraged. Additional scientists were consulted by the authors of the individual chapters where their expertise was needed. This process resulted in a group of more than 90 authors from over 30 research institutions and government agencies who are responsible for updating the Status Report on Climate Change and Health 2023.

Another important component of this project is targeted downstream science communication, which processes the results and recommendations contained in the individual articles through a wide range of tools (videos, fact sheets, social media content, digital channels, direct exchange formats) for specific target groups with public health relevance. This evidence-based communication strategy was developed at the RKI in close coordination with the advisory board and the Federal Centre for Health Education (BZgA). Some communication tools are to be tested and further developed in a participatory and iterative process involving target groups such as decision-makers and relevant stakeholders at the subnational level. Health communication is an important public health intervention in the field of climate change and health. Relevant decision-makers and the public need to know and assess increasing risks in order to act based on them.

2. Health, climate and climate change adaptation in Germany

The article presented here provides a general overview of climate change and health as the basis for the status report, particularly the climatic background and climate change-related health risks. Other articles that follow in this and two other Special Issues of the Journal of Health Monitoring ( Table 1 ) summarise the current evidence in the various fields, briefly touched on here, in which climate change interacts with wildlife and the environment to affect human health.

In the long term, the health situation in Germany has been improving steadily. For example, since the early 1990s, life expectancy of people in Germany has increased by around four years to 83.4 years for women and by around six years to 78.5 years for men [ 2 , 3 ]. Notwithstanding the increase in life expectancy, the effects of global climate change are increasingly becoming an important risk factor for health. Especially in the last few years, it has become apparent how fast climate change is reaching us. 2022 was the warmest year on record in Germany, and a pronounced spring drought occurred for the fourth year in a row [ 4 ]. Climate change will also make certain disasters more frequent, such as the heavy rain event that led to widespread flooding in July 2021, especially in Rhineland-Palatinate and North Rhine-Westphalia. Extreme events such as these can trigger disasters that are not the result of a single event, but must be understood as an interplay of different processes, modified by local conditions. These disasters may have an immediate impact, such as a physical effect on human health. However, cascading effects can also result in broader and far-reaching indirect health consequences, e. g. through lack of accessibility for emergency vehicles or through the development of chronic conditions or mental illness [ 5 ]. While climate change is most noticeable in Germany through a change in thermal stress, extreme weather events such as droughts, low water, heavy rain, storms, fires, and floods occur and can also have a strong impact on human health. In addition, there are indirect health effects moderated by natural systems, e. g. a pollen season prolonged by warmth with associated allergy burden, increased exposure to pollutants, and infections due to reduced hygiene after floods [ 6 ]. Infectious diseases not currently occurring in Germany to a significant extent are also expected to increase.

Climate change affects human health in part by altering ecosystems and, as one factor among many, exacerbates ongoing biodiversity loss. At the same time, ecosystems and their biodiversity play a role in the fluctuation of greenhouse gases and are an important lever of climate change adaptation [ 7 ]. The two crises must therefore be considered together in terms of their consequences for human health ( Info box 1 ). There is a continuing need for research into the links between climate change, biodiversity and health.

So far, the Essential Public Health Functions (EPHFs) of the World Health Organization (WHO) [ 8 ] do not yet adequately reflect environmental changes or their role in climate change mitigation and adaptation. This article therefore draws on existing concepts of core public health functions [ 9 ] that link these functions to sustainability aspects and climate resilience. Concepts such as One Health and Planetary Health, as well as the public health core functions, are considered in relation to their utility for public health practice to enable health equity in climate change.

Even though climate change has a global dimension and ultimately, effective climate protection can only succeed globally, adaptation measures must be developed and implemented primarily at the regional or local level. Climate protection (mitigation) to prevent the progression of climate change is essential, but climate change adaptation is also important to enable people to remain healthy despite the changes. This status report focuses primarily on climate change adaptation in Germany.

3. Climatic changes

3.1 climate development.

When analysing long-term climate development in Germany, it becomes clear that climate change is already observable and perceptible. It is clearly due to the anthropogenic increase of greenhouse gases in the atmosphere ( Info box 2 ). The most important anthropogenic greenhouse gas in this context is carbon dioxide (CO 2 ), which caused a change in global radiative forcing of 2.16 W/m 2 in the period from 1750 to 2019 ( Info box 3 ). Together with other greenhouse gases, such as methane, nitrous oxide, and ozone, this results in total additional positive radiative forcing of 2.72 W/m 2 , which is associated with a global temperature increase of 1.2°C since the start of the 20 th century [ 25 ]. Since area-wide measurements began in 1881, the annual mean temperature in Germany has increased by 1.6°C degrees. The rate of temperature increase in Germany (as worldwide) has increased significantly over the past 50 years: since 1881, temperatures increased by an average of 0.12°C per decade; for the last 50 years, the warming rate has been more than three times as high, at 0.38°C per decade. Since the 1960s, each decade has been significantly warmer than the previous one. The rise in mean air temperatures is also likely to lead to more and more intense weather extremes in the coming years. The increase in heatwaves and dry spells has a strong impact on health [ 26 ].

Info box 1 Importance of biodiversity for human health

Biodiversity provides ecosystem services, direct and indirect contributions of ecosystems to human well-being, which are essential for human health. The dramatic loss of biodiversity thus poses a threat to human health.

A large number of scientific publications have identified correlations between biodiversity and human health. Research into causal relationships has been funded in Germany since August 2022 with a directive from the Federal Ministry of Education and Research [ 10 ].

The diversity of the plant spectrum provides us with medicine and food, regulates water and climate, and reduces environmental risks such as air pollution. In addition, there is a connection of biodiversity with allergies and immune diseases. For example, contact with a microbe-rich environment in childhood, such as through agriculture, has been identified as a protective factor against allergies [ 11 , 12 ].

Biodiversity also plays a role in infectious diseases. For example, the risk of pandemics may increase due to human destruction and alteration of ecosystems [ 13 ]. Unsustainable consumption, agricultural intensification, and wildlife trade lead to increased contact between humans and wildlife, triggering a variety of zoonotic diseases. Thus, biodiversity conservation has an important preventive role.

Contribution of biodiversity to mental health and human well-being

Spending time in nature has a positive effect on human well-being and mental health; this has been well researched for some time. Urban green spaces, gardens, forests, and bodies of water provide opportunities for recreation [ 14 ], stress reduction [ 15 ], and social interactions.

However, it has not yet been clearly established whether this effect is also stronger the more diverse the nature surrounding humans is, since socioeconomic factors, cultural background and aesthetic preference of the study participants, but also the definition of biodiversity and health of the respective study play a role [ 16–18 ].

Cultural ecosystem services also make an important contribution to mental health [ 19 ]. People value diverse ecosystems and some species for their beauty, feel connected to them, and identify with a particular environment.

Synergies between climate change adaptation, public health strategies, and conservation

Given the complex interrelationships between climate change, biodiversity loss, and human health ( Figure 1 ), there are important synergies between climate change adaptation, public health measures, and nature conservation [ 20 ]. Nature-based solutions can achieve positive outcomes in terms of both health and adaptation to climate change, so-called co-benefits [ 21 ]. One example is the expansion of urban green space and urban blue infrastructure. This includes roadside trees and street greenery, greening of facades and green roofs, and larger green spaces (parks, playgrounds) that promote recreation, air pollution control, and microclimate [ 22 ]. To simultaneously serve biodiversity conservation, this greenery should be as diverse as possible. Socioeconomically disadvantaged people in particular benefit from nature-based health interventions in cities [ 23 ]. In view of increasing urbanisation worldwide – it is predicted that 68% of the world's population will already live in cities by 2050 [ 24 ] – the development of urban, diverse greenery should therefore not be underestimated as an important public health measure.

Direct and indirect effects of climate change on health

Illustration: Robert Koch Institute

According to the German coordination office of the Intergovernmental Panel on Climate Change (IPCC), global air temperatures will continue to rise until at least mid-century under all emissions scenarios considered. Global warming of 1.5°C and even 2°C is likely to be exceeded during the 21 st century unless drastic reductions in CO 2 and other greenhouse gas emissions occur in the coming years [ 27 ]. Many changes in the climate system are amplified in direct relation to increasing global warming [ 25 ]. Natural factors and internal variability will modulate human-induced forcing, especially at regional scales and in the near future. It is important to consider these modulations when planning for the full range of potential impacts. As global warming continues, projections indicate that simultaneous and multiple modifications of climatic impact drivers (CIDs) will increasingly occur in nearly all regions. Regional climatic impacts are predominantly negative in nature, although there are some regions that could benefit from climate change. Changes in several CIDs would be more widespread at 2°C compared to 1.5°C global warming, and even more widespread and/or pronounced at higher levels of warming. Effects with low probability of occurrence – such as ice sheet collapse, abrupt changes in ocean circulation, some compound extreme events, and warming substantially beyond the range assessed as very likely – cannot be ruled out and are part of the risk assessment [ 25 ].

From a natural science perspective, limiting human-induced global warming to a certain level requires limiting cumulative CO 2 emissions, achieving at least net zero CO 2 emissions, along with strong reductions in other greenhouse gas emissions. Strong, rapid, and sustained reductions in greenhouse gas emissions would also limit the warming effect resulting from declining air pollution, since aerosols (especially particulate matter) have predominantly negative radiative forcing and their projected decline by mid-century will have an additional warming effect [ 28 ].

Info box 2 Greenhouse effect

The greenhouse effect is a natural process that significantly determines the temperature on Earth. Water vapour and carbon dioxide are the two main natural greenhouse gases that cause the global mean temperature to be a comfortable 15°C, rather than -19°C, as it would be without the presence of the Earth's atmosphere. Increasing the concentrations of atmospheric trace gases such as carbon dioxide, methane, and nitrous oxide creates an additional (anthropogenic) greenhouse effect. This results in further warming of the lower atmosphere and affects the entire climate system.

Info box 3 Radiative forcing

The additional radiative forcing is the change in net insolation (incoming solar radiation minus outgoing radiation, expressed in watts per square meter, W/m 2 ) at the top of the troposphere, the lowest layer of the Earth's atmosphere. This change occurs due to anthropogenic climate change, primarily by increasing the concentration of greenhouse gases in the atmosphere. The additional radiative forcing is defined as the change from the year 1750. The numbers in the representative concentration pathways (RCP) climate scenario names, e. g. RCP2.6 or RCP8.5, refer to the expected change in radiative forcing of 2.6 W/m 2 and 8.5 W/m 2 , respectively..

3.2 Climate models and climate projections

Climate models provide information about the future development of the climate. The calculated future projections depend, among other factors, on the assumed development of human society. In order to be able to represent these potential global developments, scenarios have been developed over the past decades from which different development paths of emission and concentration scenarios of greenhouse gases and aerosols can be derived. The oldest scenario family (special report on emissions scenarios, SRES) reflects the state of knowledge at the turn of the millennium, the subsequent generation of scenarios (representative concentration pathways, RCP) was developed for the IPCC’s Fifth Assessment Report, and now considers other factors such as climate change mitigation and adaptation [ 29 ]. The latest generation is called shared socioeconomic pathways (SSP) and focuses on changing socioeconomic factors, such as population, economic growth, education, urbanisation, and the pace of technological development [ 30 ]. In doing so, the SSP identify five different ways in which the world could develop without climate policies and how different levels of climate action could be achieved. In doing so, the climate mitigation targets of the RCP are combined with the SSP. The RCP set pathways for greenhouse gas concentrations and thus the amount of warming that could occur by the end of the century. The SSP, on the other hand, provide the framework within which emissions reductions are achieved (or not achieved) [ 31 ].

The five socioeconomic development paths of the SSP scenarios (SSP1 to SSP5), are associated with additional radiative forcing (1.9 to 8.5 W/m 2 ). Scenarios with low or very low greenhouse gas emissions (SSP1-1.9 and SSP1-2.6) lead to detectable positive impacts on greenhouse gas concentrations as well as air quality in a matter of years compared to scenarios with high and very high greenhouse gas emissions (SSP3-7.0 or SSP5-8.5). When comparing these contrasting scenarios, discernible differences between global air temperature trends begin to emerge from natural variability within about 20 years.

4. Impact of climate change on health

The Climate Impact and Risk Assessment 2021 for Germany lists eight climate risks in the field of human health, which are also in line with the structure of this status report and the following sections [ 32 ]: heat stress, UV-related health damage, allergic reactions, potentially harmful micro-organisms and algae, distribution and change in abundance of possible vectors, respiratory issues due to air pollution, injuries and deaths as a result of extreme events, and effects on the healthcare system.

These impacts of climate change on humans and the environment are highly dependent on geographic region, human use of the environment, and social determinants [ 33 ]. Any person can be affected by diseases that are influenced by, at different temporal scales, weather and climate; nevertheless, there are parts of the population that are much more vulnerable to the health consequences (like heatwaves) of climate change and, in some cases, respond more strongly. In particular, these are individuals vulnerable due to their age or those weakened by immune or other pre-existing conditions. In addition, there are groups of people who are exposed to health-threatening situations longer and more frequently than others due to occupational or private activities [ 33 ]. Interdependencies between age, gender, work/housing conditions and location, income or poverty as well as education status also play a role here [ 34 ]. In a coming article of this status report on climate change and health, this topic is discussed in more detail (Bolte et al. [ 35 ]).

Accordingly, different groups have very different needs and requirements of the healthcare system. This shows that the climate impacts described above not only affect individuals, but also have a significant impact on the healthcare system and its players, and thus have organisational and economic components. Health in particular has many cross-connections with other fields of action [ 36 ].

Health is not only an individual concern, but above all a social task. Various prevention and health promotion measures can enable people to behave in a way that promotes health by adapting to climate change and its effects. These include interventions such as educational campaigns, like the website ‘Klima-Mensch-Gesundheit’ (Climate-Human-Health) of the BZgA. However, these measures should always be combined with a change in people’s living conditions, because health behaviour is difficult to enforce against resistance from the social environment or living conditions. These so-called structural preventive measures include, for example, the expansion of infrastructure and services offered (e. g. bicycle paths, climate-friendly cafeteria food, shaded public areas, access to urban greenery) or pricing policies (e. g. promoting climate-neutral construction). These complex interventions require the involvement of many social groups and sectors beyond health, for example by cooperating with actors from the transport, construction or environmental sectors. Such an approach requires that health is considered in all policies, so that health-promoting lifestyles actually become the easiest for people in everyday life, as the WHO demands (‘Make the healthy way the easy way’) [ 37 ].

Many consequences of global warming interact with each other and can reinforce each other through feedback effects. In addition to the direct effects of climate change on human health – in Western Europe primarily through increased occurrence of extreme weather events such as heatwaves – indirect effects can also be observed, which are brought about through changes in natural systems (atmosphere, bio-, hydro-, cryo- and pedosphere) ( Figure 1 ). Weather conditions determine the local meteorological conditions to a large extent, as well as air and radiation hygiene. For example, long-lasting summer high-pressure weather conditions not only lead to thermal stress due to high air temperatures, but also to increased exposure to ozone and UV radiation. Climate change causes changes to infectious diseases whose pathogens are transmitted via blood-sucking arthropods, infections that are water or food-related, and changes in the area of allergenic plants and animals. In addition, progressive climate change can cause further changes relevant to health, like an increase in drought episodes, which indirectly affect health, e. g. via insufficient water supply, crop failures or the increase in forest fires, or an increase in flooding events, which can lead to the spread of certain pathogens. Both are already a major challenge today [ 38–40 ].

The various impacts of climate change on health are briefly touched on here and addressed in detail in subsequent articles in this and the next Special Issue in the Climate Change and Health series of articles, with reference to both communicable diseases and non-communicable diseases, including mental health impairments.

4.1 Impact of climate change on communicable diseases

Vector and rodent associated infectious diseases.

According to a study by McIntyre et al. [ 41 ], nearly two-thirds of the human and domestic animal disease pathogens found in Europe are climate sensitive. Climatic conditions favour, among other things, the outbreak of vector-associated diseases such as chikungunya, dengue, and West Nile fever in Europe and contribute to the further geographic spread of vectors that transmit the causative agents of Lyme borreliosis and tick-borne encephalitis.

Transmission of vector-associated pathogens requires an introduced or established vector population, a pathogen, and appropriate environmental and climatic conditions throughout the pathogen transmission cycle. Environmental and climatic conditions affect each of these areas, from vector survival and abundance to pathogen growth and survival in vector organisms, to vector activity and sting frequencies, to human exposure to disease vectors.

Even if, for example, the introduction of Aedes albopictus (Asian tiger mosquito) is primarily favoured by globalisation, especially along transport routes [ 42 ], climate change is associated with the active potential spread of vectors and pathogens, which is why a further shift of certain tick species to higher latitudes and altitudes and a further geographical spread of mosquito and sandfly species should be expected in Germany in the coming years [ 43 ]. Another article in this status report is dedicated in detail to vector- and rodent-associated diseases in climate change ( Beermann et al. [ 44 ])

Waterborne infections and intoxications

Waterborne pathogens may also be subject to the influence of climate change. The increase in sea surface temperatures, as evidenced by measurements in the North Sea and Baltic Sea (in the North Sea, temperature increased by about 1.3°C over the last 50 years) [ 45 ], will continue in the future and accelerates the proliferation of the bacterial genus Vibrio , for example [ 46 , 47 ]. Vibrio infections mainly manifest as wound infections and diarrhoeal diseases. Climate warming with accompanying increased water temperatures could lead to higher Vibrio concentrations, making an increase in infections more likely [ 47–49 ]. Projections indicate that the sea surface temperature of the North Sea will warm by 1°C to 3°C by the end of the 21 st century, and that of the Baltic Sea by 3°C to 4°C, with strongest warming rates in the northern part of the Baltic Sea [ 50 ]. In addition, extreme precipitation events may lead to outbreaks of waterborne diseases [ 49 ]. The topic of waterborne infections and intoxications is dealt with in more detail in another article in this status report ( Dupke et al. [ 51 ]).

Foodborne infections and intoxications

Foodborne infections and intoxications also play a role in the context of climate change, as the incidence of associated diseases can be affected by temperature changes. Examples include bacterial gastrointestinal infections caused by the mostly foodborne pathogens Campylobacter and Salmonella . Transmission to humans usually occurs through food. Salmonella infections increase linearly with air temperature by 5 to 10% per °C [ 52 ]. Thus, longer summers allow increased transmission of foodborne pathogens [ 49 ]. More detailed findings can be found in another paper in this status report ( Dietrich et al. [ 53 ]).

Antimicrobial resistance (AMR)

One link between health and climate change that has received little attention is antibiotic-resistant infections [ 54 ]. Bacteria that cause infections in humans can develop resistance to antibiotics. Resistance against antimicrobial agents (in bacteria and other microbes) causes significant morbidity and mortality worldwide, posing enormous challenges to health systems and basic public health functions globally. Antibiotic resistance in bacteria is thought to develop mainly under the selection pressure of antibiotic use. However, other factors, such as climate change, may also contribute to the increase in antibiotic resistance. MacFadden et al. [ 55 ] reported that a 10°C increase in temperature in experimental laboratory settings was associated with an increase in antibiotic resistance in the common pathogens Escherichia coli (+4.2%), Klebsiella pneumoniae (+2.2%), and Staphylococcus aureus (+2.7%). In another contribution to this status report, Meinen et al. [ 56 ] provide a systematic review on AMR in climate change.

4.2 Impact of climate change on non-communicable diseases and mental health

Health impact due to air pollutants.

In recent decades, air quality in Germany has improved considerably thanks to targeted air pollution control measures [ 57 ]. However, if emissions remain constant, there would be an increase in ground-level ozone and particulate matter concentrations as a result of climate change. Warmer summers and, in particular, an increase in extreme temperature events favour the formation of ground-level ozone, as stagnant air circulation during pronounced high-pressure weather conditions can cause ozone to accumulate and allow peak levels to occur over several days [ 58 , 59 ]. Increased particulate matter exposure, e. g. due to increasingly dry soils and more frequent vegetation fires, can cause cardiovascular disease in addition to impaired lung function and serious lung diseases such as asthma and lung cancer. Likewise, there is a significant relationship between cardiovascular mortality and levels of ground-level ozone, with even short-term exposure to ozone increasing health risk and moderately high levels of ozone being associated with increasing rates of myocardial infarction [ 60 , 61 ]. Further health impacts arise from increased heat stress, especially in combination with increased air pollutants [ 62 , 63 ]. In a contribution to this status report, Breitner-Busch et al. [ 64 ] provide an overview of climate change-related health effects from air pollutants that are particularly relevant for Germany, and explain the effects of air pollutants in conjunction with air temperature. Furthermore, an overview of limit, target and guideline values in the current context of the air situation in Germany is given, and the current WHO guideline values are discussed. Corresponding recommendations for the public health sector are presented.

Health impact due to heat

Heat events usually occur over large areas and affect individual groups, especially younger and older people, but are also cross-sectoral [ 65 ]. Heatwaves will increase in terms of intensity, duration, and frequency ( Figure 2 ). The characteristics of heatwaves, their number, duration, and intensity, as well as their temporal occurrence within a year, are relevant for estimating the health burden during and after high thermal stress. In particular, the duration of a heatwave can increase mortality, and the disproportionate increase in long heatwaves can therefore lead to a sharp increase in the number of deaths [ 66 ]. For example, RCP scenarios for Germany project an increase in mortality from chronic lower respiratory diseases (CLRD) during long heatwaves (≥10 days) of up to 150% by mid-century. Depending on the scenario, there could be an increase of between 260% (RCP4.5) to a maximum of 540% (RCP8.5) by the end of the century. According to RCP4.5 and RCP8.5, mortality from ischemic heart disease (IHD), which involves narrowing of the coronary arteries, could be 90% (RCP4.5) or 150% (RCP8.5) higher between 2021 and 2050, and as much as 330% (RCP4.5) higher to a maximum of 900% (RCP8.5) between 2068 and 2097 [ 67 ]. This indicates that even under moderate climate change, significant health effects from heat can be expected. In a subsequent article of this status report Winklmayr et al. [ 68 ] address the health effects of high temperatures, which particularly affect older persons and people with certain pre-existing conditions.

Figure 2a Number of hot days per year.

Regional distribution of the number of hot days with a maximum temperature of at least 30°C, 2011–2020

Source: German Meteorological Service

Figure 2b Number of heatwaves per year

Figure 2c Number of days per heatwave

Figure 2d Mean air temperature (°C) of heatwaves

2b – 2d in Germany, based on historical (measured) datasets, HYRAS (gridded dataset) [ 69 ], and projections under the RCP4.5 and RCP8.5 climate scenarios

Source: Own representation based on Schlegel et al. [ 67 ]

Health impacts from extreme weather events

Increases in intense rainfall can cause devastating floods that directly affect the lives and health of the population and health infrastructure. The intensity of rainfall in Germany and Western Europe has already increased by up to 19% due to climate change. Flooding events, such as those in western Germany and Belgium in 2021, have become up to nine times more likely. If global warming approaches the 2°C threshold, this will be directly reflected in precipitation intensities (increase of up to 6%) and flood probabilities [ 70 ].

However, increased dryness and drought must also be expected, especially in the summer months. Modelling has shown that with a warming of 3°C by the end of the century, twice as many days of drought are to be expected in Germany [ 71 ]. Historical data show that various regions of Germany are already suffering from increasing drought [ 72 ]. In addition to stressful situations in agriculture, low water levels and falling groundwater levels, this can also have an impact on air quality. Dry soils contribute to a worsening of air quality by dust and particulate matter due to drifting. Prolonged drought also increases the time pollen stays airborne, and more frequent forest fires contribute locally to increased exposure to particulate matter. Drought stress in plants also reduces the uptake of ozone, thereby increasing the ground-level ozone concentration that is harmful to health, and thus increasing the incidence of respiratory diseases [ 73 ]. In another contribution to this status report, Butsch et al. [ 74 ] provide an overview of health impacts due to increased extreme weather events occurring under climate change. According to this article, such indirect or long-term meteorological consequences can be countered by risk management and disaster relief in order to mitigate the health consequences of extreme events as far as possible, especially for vulnerable groups.

Health effects due to increased allergen exposure

Climate change has an influence on allergen exposure. For example, increased pollen production and an earlier pollen season support the occurrence and increase the frequency of pollen-associated allergic respiratory diseases [ 75 ]. In addition, higher temperatures and an increase in the air’s CO 2 content can lead to an increase in the allergenicity of pollen and thus cause stronger allergic reactions [ 76 ]. Climate change-induced changes in vegetation zones also allow alien species to colonise and spread in areas where they were not previously native. For Europe, for example, the ragweed plant with its high allergenic potential is a cause for concern [ 6 , 75 , 77 ]. Bergmann et al. [ 78 ], in another contribution to this status report, deal in detail with the topic of climate change-induced changes in allergen exposure and their health consequences, show the connection to other exposures such as air temperature and air pollutants, and give recommendations for action.

Health effects due to altered UV radiation exposure

Climate change has an influence on ground-level UV radiation and the annual UV radiation dose. For Germany, the effects of greenhouse gases on stratospheric ozone and especially cloud cover play a decisive role here. Projections for stratospheric ozone and cloud density are subject to very large uncertainties. However, in recent years, a significant increase in sunshine duration has been recorded in Germany and, consequently, an increase in the daily sums of erythemally effective UV radiation annual dose [ 79 , 80 ]. The occurrence of UV radiation-related diseases of the skin and eyes, including cancers, depends not only on the prevailing ground-level UV irradiance in the environment (ambient UV radiation) of people and the UV radiation annual dose, but is also decisively determined by the exposure behaviour of people. The current state of knowledge on effects of climate change on UV radiation exposure and health consequences are described in a contribution to this status report by Baldermann et al. [ 81 ].

Impact of climate change on mental health

In addition to increasing general concern among many people about the future of the planet, climate change may have other consequences for mental health. The effects of climate change-related weather events and natural disasters on mental health have been known for some time. They cause problems such as sleep disorders, stress, anxiety, depression, and the development of post-traumatic stress disorder and suicidal ideation [ 82 ]. However, less research has been done on the psychological and emotional consequences generated by awareness of the slow and gradual changes in the environment caused by human-induced climate change and what measures can effectively protect vulnerable groups in particular. Studies show that people experience feelings of loss, helplessness, and frustration due to the threat of climate change – a condition now referred to as eco anxiety [ 83 ]. In a further contribution to this status report, Gebhardt et al. [ 84 ] address this issue and examine the topics of extreme weather events, temperature increase, perception and inner-psychological processing of climate change, psychological-sociological aspects, as well as the ability to act and resilience factors.

5. Conceptual frameworks for addressing the climate crisis

The concepts of One Health and Planetary Health have gained momentum since the early 2000s; they can provide a framework for addressing the climate crisis. Inherent in their systemic-holistic approach is a broader view of possible solutions to problems of environmental change and health.

Both concepts are subject to constant further development and thus do not represent rigid monoliths. As a result, both approaches can be instrumental in achieving many of the goals of the United Nations’ ‘2030 Agenda for Sustainable Development’ (Sustainable Development Goals), thus significantly strengthening that agenda and ultimately improving environmental health [ 85 ]. The impacts of climate change affect variously interrelated systems, such as the relationship between the economy, energy, the environment, and health, and thus can only be understood and resolved across these fields [ 27 ]. In order to improve the protection of human health, the interrelationships between human and animal health and healthy ecosystems must therefore be considered more seriously in a wide range of policy areas.

5.1 One Health

The concept of One Health was proposed by Schwabe [ 86 ] in 1964, when he coined the term ‘One Medicine’ for the areas encompassing human and veterinary health. Since then, the concept of One Health has been extended to include the environmental aspect: humans are a part of the animal kingdom, which in turn is embedded in a common environment [ 87 ]. The ‘Berlin Principles’ recently further enriched the One Health concept [ 88 ]. They emphasise the institutional strengthening needed to ensure the translation of science-based knowledge into policy and practice, as well as the need for action in addressing the climate crisis.

The One Health High-Level Expert Panel (OHHLEP) was convened by WHO and other organisations in order to initiate the implementation of the One Health approach from theory to practice. Four areas were deemed essential: communication, coordination, collaboration, and capacity building [ 89 ]. The balance between sectors and disciplines should be considered, sociopolitical and multicultural parity, socioecological balance, human responsibility, as well as transdisciplinarity and multisectoral collaboration across all relevant disciplines.

Through the One Health concept, a holistic view of all affected areas can reinforce synergistic approaches along responsible administrative and executive levels, in order to achieve solutions that can reduce the effects of climate change or implement adaptation strategies. For example, the costs resulting from the emergence of new zoonoses could be significantly lower if they were identified early on as potential zoonoses in animals rather than appearing later in humans [ 90 ].

5.2 Planetary Health

Planetary Health is a concept that relates human health to political, economic, and social systems, as well as the ecological boundaries of our planet [ 91 ]. It highlights the dominance and impact of human activities on shaping our environment, and calls for the associated responsibility and recognition of planetary boundaries. By transforming toward health within planetary boundaries, ecological stress limits are no longer exceeded, while current and future generations are enabled to live healthy, dignified lives in safety through effective and sustainable political, social, and economic systems [ 92 ]. Planetary Health is a health narrative based on sustainability and the critique of growth economies, which builds on interdisciplinary as well as intersectoral engagement with the complex relationships between and within ecosystems. The understanding of Planetary Health goes beyond the isolated consideration of environment and climate. In Germany, political Planetary Health recommendations for the field of climate change and health were formulated in the 2021 Lancet Countdown Policy Brief as follows [ 93 ]:

(1) the systematic and widespread implementation of heat-health action plans to reduce heat-related health risks,

(2) the reduction of the CO 2 footprint of the German healthcare sector and

(3) the integration of climate change and health/Planetary Health in education and training of health professionals.

5.3 Climate change mitigation and adaptation as tasks for the health care system

Evidence and knowledge about the impact of climate change have continued to grow in recent years, and climate change mitigation and adaptation strategies have been developed both globally and nationally.

Pivotal at the global level is the Paris Agreement, which was adopted at the 21 st Conference of the Parties of the United Nations Framework Convention on Climate Change (COP21) in December 2015. The signatory states pledged to limit global warming to well below 2°C, but preferably to 1.5°C, compared with pre-industrial levels. At COP26 in Glasgow, all states agreed to accelerate the global energy transition away from coal combustion; at COP27 2022 in Egypt, this acceleration was not evident.

In 2022, the German G7 presidency placed climate change and health on the political agenda of those seven industrialised countries that have joined together as the ‘Group of 7’, thus promoting national and international attention to climate-neutral and climate-resilient health systems.

At the federal level, the Climate Change Act guides the actions of the healthcare system in enforcing climate protection. This law was amended by a decision of the Federal Constitutional Court. The decision stated that requiring only a mild reduction in CO 2 consumption of the current generation and allowing them to use up most of the remaining CO 2 budget is unconstitutional as it leaves future generations with a high reduction burden, and exposes them to extensive losses of freedom [ 94 ]. The German government has set up a climate protection programme and is preparing a climate change adaptation strategy [ 95 ]. A national prevention plan is also in preparation, which, among other things, will introduce concrete measures against climate and environment-related health damage. The National Prevention Conference outlines tasks facing individual actors in this context [ 96 ]. A climate adaptation act will create a framework for implementing the national climate change adaptation strategy with measurable targets in cooperation with the federal states.

In 2008, the German government set the strategic framework with the German Strategy for Adaptation to Climate Change (Deutsche Klimaanpassungsstrategie, DAS), to counter the effects of climate change with a focus on 16 fields of action [ 97 ]. A network of all federal ministries and 28 higher federal authorities is involved. Measurable targets are being developed in many clustered topics, including health.

Most political activities related to climate change adaptation involve protection against heat. According to a resolution of the 93 rd conference of German federal health ministers, heat-health action plans are to be drawn up in federal states and municipalities nationwide by 2025 [ 98 ]. The recommendations, which can be used as a model, were developed jointly by the Federal Ministry for the Environment, Nature Conservation, Nuclear Safety and Consumer Protection, the BMG and the federal states [ 99 ].

Even in the absence of concrete targets and measures on how the healthcare system can become climate-neutral and climate-resilient, some transformative action is evident at the level of healthcare actors and institutions. For example, the 125 th German Medical Assembly called for a national strategy for climate-friendly healthcare [ 100 ]. In December 2022, the BMG, leading organisations in the health care sector, the federal states and municipal umbrella organisations signed the Climate Pact for Health and declared their intention to work together for adaptation and mitigation in the healthcare sector [ 101 ]. It is important to note that mandates in the German healthcare system are very heterogeneous, and responsibility is distributed in a complex manner among different levels and within the self-governance of involved actors.

Health must not be considered alone in the development and implementation of mitigation and adaptation measures; health must be considered in all departments in the sense of ‘Health in all Policies’. Co-benefits are achieved through measures that are both good for the climate and the environment, and promise public health benefits through risk reduction or health promotion. In particular, the areas of renewable energy (reducing emissions and improving air quality), active rather than motorised mobility (reducing emissions, improving air quality, and increasing physical activity), and plant-based diets (reducing emissions and reducing non-communicable diseases) hold great potential for these co-benefits [ 102 ]. Because of the synergies between climate change adaptation, the improvement of human health, and biodiversity conservation, more partnerships should be formed between urban planning, landscape design, conservation, and health and other sectors.

5.4 Transformation toward a resilient public health system

It is apparent that a systemic view via the One Health or Planetary Health approaches is necessary for climate change adaptation and climate protection.

Brown and Westaway [ 103 ] describe how successfully dealing with adversity and challenges can entail a reorganisation or transformation of systems in which adaptive functions are optimised. The transformative consequence of resilient behaviour is also reflected in current thinking about environmental change and socioecological systems.

In particular, the WHO definition of resilience provides a comprehensive description in this context. The WHO defines resilience as the ability of a health system to prepare for, cope with, and learn from shock events, among other things, while maintaining the core functions of the health system [ 104 ]. Ideally, resilience is not a return to the original state, but an evolution to a better state [ 105 ]. Transformation as part of health system resilience can refer to the system’s ability to change practices, re-design certain services or public health programs to be more accessible, or it can refer to medical and technological breakthroughs. Resilience at the system level can be strengthened by introducing new financing mechanisms; this can increase the economic sustainability of the system and its ability to anticipate and counter potential future crises.

In addition to enabling health systems to better cope with climate change-related challenges, health care institutions must also do their part to mitigate climate change. The healthcare sector contributes significantly to the emission of greenhouse gases worldwide. The healthcare sector’s share of German greenhouse gas emissions ranges from 5.2% [ 106 ] to 6.7% [ 107 ], depending on the estimate. Currently, there is no legal obligation for standardised reporting of greenhouse gas emissions in the German healthcare sector. Only a few healthcare facilities document their emissions voluntarily [ 93 ].

Relevant areas for reducing the ecological footprint of hospitals, the pharmaceutical industry and other healthcare facilities include the manufacture and supply chains of drugs and medical devices, construction, energy supply, nutrition or communal catering, waste reduction and separation, climate-friendly alternatives in consumables (from anaesthetic gases to single-use instruments to office materials), and environmentally friendly workplace health promotion and occupational safety. Physicians enjoy a high degree of trust among the population and therefore have an important societal role to play in raising awareness and changing behaviour in favour of co-benefits, e. g. diets that emit little CO 2 and also promote health [ 108 ].

To address and adapt to the challenges of environmental determinants of health, an integrated and evidence-based approach is needed in healthcare, public health, and across sectors, informed by good governance, appropriate management mechanisms, high-level political will, and adequate human, technical, technological, and financial resources. The WHO is currently further developing approaches that incorporate climate change into health concepts, such as the Essential Public Health Functions (EPHFs), a model for assessing and developing public health structures and their functions [ 9 , 109 ]. These core functions for public health provide guidance to public health systems; however, publications that apply to the European region have so far given too little consideration to environmental and climate aspects. The German Zukunftsforum Public Health (future forum on public health) published a ‘Call for and to Action: Climate Change and Public Health’ in the summer of 2022, which formulated recommendations for public health stakeholders and policy makers on this topic. The core functions of public health are addressed, but not yet fully formulated [ 110 ].

Although the public health core functions for Germany and Europe have not yet been formulated to include climate change and environmental aspects, the core functions of the Pan American Health Organization (PAHO) of the WHO already refer to climate resilience and sustainability [ 9 ]:

(1) Monitoring and evaluation of health and well-being, equity, and social determinants of health to determine their impact on environmental public health

(2) Environmental health surveillance of environmental hazards, exposures, health risks, and risk management measures

(3) Promotion and management of environmental health research and knowledge

(4) Development and implementation of environmental health policies and promotion of legislation in this area

(5) Participation and social mobilisation to promote communication and action on environmental determinants of health

(6) Development of human resources for environmental public health

(7) Use and management of essential medicines and health technologies in an environmentally safe and sustainable manner to protect public health

(8) Efficient and equitable financing of environmental public health

(9) Equitable access to health care facilities that are climate resilient and environmentally sustainable

(10) Equitable access to environmental public health interventions that promote health, reduce risk factors, and promote healthy behaviours

(11) Including the environmental public health dimension in the management and promotion of interventions on social determinants of health.

The complete elaboration of a concept on public health and environmental and climate factors is still pending. However, the individual articles and, in particular, the final article of this Status Report on Climate Change and Health can make a substantial contribution to this and use the preliminary work described. The following articles list recommendations for action, the implementation of which can reduce the impact of climate change for the public health sector. To conclude the series of articles, these recommendations will be revisited in a separate article and related to the public health core functions mentioned above in order to provide guidance to public health actors in strengthening the resilience of the healthcare system.

The authors of all the articles published in this series thus present an up-to-date, actionable report focused on Germany that stresses our ability to act in the face of the threats posed by climate change and provides actors with a solid basis for concrete action. The scientific evidence is overwhelming, the status report provides orientation – action must now be taken.

Key statement

• Global man-made climate change will continue to progress and affect human health.
• Biodiversity contributes directly and indirectly to human health.
• Protecting and restoring biodiversity is an important public health measure.
• The direct and indirect effects of climate change on human health are highly dependent on region, social factors, and human behaviour.
• Climate change has an impact on people’s physical and mental health. Not all people can protect themselves equally well against climate change impacts.
• Basic public health functions will be severely challenged by climate change impacts.
• A climate-resilient health system could be guided by internationally established Essential Public Health Functions.

Acknowledgement

The authors would like to thank Stefan Muthers (DWD) for providing the data for figure 2 and the authors of the following articles of this status report for their cooperation. The KlimGesundAkt coordination team at Robert Koch Institute would like to thank the following persons for their work on the project’s advisory board: Sophie Gepp, Elke Hertig, Claudia Hornberg, Tanja-Maria Kessel, Andreas Matzarakis, Odile Mekel, Susanne Moebus, Jonas Schmidt-Chanasit, Alexandra Schneider, Klaus Stark, Wolfgang Straff and Maike Voss.

Funding Statement

The publication was coordinated through the project KlimGesundAkt, which is funded by the Federal Ministry of Health (chapter 1504; title 54401 HJ2021; duration 07/2021–06/2024). Elke Hertig is funded by the German Research Foundation under project number 408057478.

The German version of the article is available at: www.rki.de/jhealthmonit

Conflicts of interest

The authors declared no conflicts of interest.

Authors’ Contributions

All authors have made comparable contributions and are listed in alphabetical order.

Note: External contributions do not necessarily reflect the opinions of the Robert Koch Institute.

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Healthcare Practices and Beliefs: German Health Practices and French Canadian Heritage

Health care beliefs: introduction, german heritage and healthcare practices, french canadian heritage and french culture health beliefs, influence on the conventional medicine, peruvian healthcare similarities, chosen health care beliefs and rationale, video voice-over.

Cultural beliefs have a significant effect on health. They influence the patient perception of disease etiology and pain, health-seeking behaviors, and health care preferences, among others. Cultural competence is required to include such beliefs in evidence-based diagnosis and treatment. Adequate knowledge of a patient’s culture can help provide optimal care that meets his or her needs. This paper discusses the health care beliefs of people of German and French-Canadian heritage and their influence on evidence-based care delivery, the similarity with those of the writer, and the preferred choice and rationale.

Although the German Diaspora often practices Western medicine, conservative groups still hold on to their cultural beliefs. Low German (LG) Mennonites, a community that settled in Canada in the 1800s, are known to be highly religious (Kulig & Fan, 2016). As such, they view psychological health from a spiritual context. Kulig and Fan (2016) found that LG Mennonites believe that mental wellness results from a divine will. They attribute the development of psychological disorders to have weak nerves or ‘narfun trouble. Their perspectives on the level of control a patient has over his or her condition are also significant. They consider mental illness genetic, and therefore, it cannot be controlled through conventional interventions (Kulig & Fan, 2016).

LG Mennonites also associate psychological disorders with drug use, stress, and domestic violence. Spiritual wellness is considered important for mental health and the two are interdependent (Kulig & Fan, 2016). Thus, this group regards religion (prayer) as a protective factor against stress that predisposes a person to mental illnesses. LG Mennonites do not feel that autism and Alzheimer’s disease are psychological conditions that require medical attention. They also believe that a person’s life and experiences, including psychiatric conditions, are predetermined and result from sin (Kulig & Fan, 2016). Therefore, stigma and shame are associated with mental illness in this community.

The beliefs and attitudes of French-Canadians towards healthcare affect the diagnosis and management of different conditions. In particular, their limited awareness and perceptions of chronic pain (CP) result in underreporting and suboptimal treatment of this condition (Lacasse, Choinière, & Connelly, 2017). They are unaware that CP is a post-surgical complication, reflecting a significant knowledge gap. Many French-Canadians believe that healthcare professionals are not skilled in CP management and feel that CP treatment leads to medication (opioid) dependence and psychological services are reserved for depression (Lacasse et al., 2017). They also show negative attitudes towards people complaining of CP, indicating limited social support to such patients in this community.

Cultural variations in health beliefs exist between Francophone groups and First Nation Canadians. The French-Canadians are more inclined to individual wellness than on family and community health (Levesque & Li, 2014). Thus, they are less likely to engage in activities meant to support the health of others in their locality. However, compared to indigenous communities, French-Canadians value physical health, reflecting the body-centered view of people of this heritage (Levesque & Li, 2014). For them, health promotion efforts must encompass traditions and cultural integrity. Like Anglophones, French-Canadians place a higher emphasis on healthy lifestyles. They believe that healthier meals, exercise, and adequate sleep are critical to physical health (Levesque & Li, 2014). This view reflects their individualistic values and autonomy common to people of European heritage.

The beliefs about the etiology and symptoms of mental illness, predetermined life experiences, stigmatization, and a perceived limited level of control of a patient may affect the utilization of mental health services among people of German heritage. Therefore, LG Mennonites may reject evidence-based psychotherapy (CBT) and medication if delivery is not sensitive to their spirituality. For the French-Canadians, their limited understanding of CP and negative attitudes may impede family or social support for people suffering from CP. However, they value physical health; hence, they may be receptive to interventions that promote healthy eating and exercise.

The healthcare beliefs of the two cultures discussed above bear significant similarities with my heritage – Peruvian. First, people of German descent and those from Peru attribute illness to forces beyond personal control. Additionally, in both cultures, ill-health is viewed as having a spiritual component and physical and psychological dimensions. Thus, seeking traditional treatments in addition to conventional therapy is a common practice. Second, Peruvian migrants and French-Canadians associate chronic pain with the presence of disease; thus, less severe painful sensation may not be reported.

Cultural beliefs about disease causation influence the utilization of health care services. I would choose the health care beliefs of people of German heritage because they exhibit a collectivistic orientation. In particular, the (LG) Mennonites emphasis on prayer and family support is consistent with holistic care principles. Perhaps because of my Peruvian background, which centers on community needs and traditional healing, I would choose the health care beliefs of LG Mennonites in Canada.

Culture defines peoples’ perception of health and wellness, disease causes, symptoms, and care utilization. From the discussion, people of German heritage believe in a spiritual basis for illness, limited patient control over psychological conditions, and the protective role of prayer. In contrast, French-Canadians are unaware that chronic pain is a post-surgical complication, associate medication use with addiction, and emphasize physical wellness. Cultural competence and sensitivity are required to provide optimal care to these groups.

Kulig, J., & Fan, H. Y. (2016). Mental health beliefs and practices among Low German Mennonites: Application to practice . Lethbridge, AB: University of Lethbridge.

Lacasse, A., Choinière, M., & Connelly, J. (2017). Knowledge, beliefs, and attitudes of the Quebec population toward chronic pain: Where are we now? Canadian Journal of Pain, 1 (1), 151-160. Web.

Levesque, A., & Li, H. Z. (2014). The relationship between culture, health conceptions, and health practices: A qualitative-quantitative approach. Journal of Cross-Cultural Psychology, 45 (4), 628-245. Web.

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NursingBird. (2023, August 11). Healthcare Practices and Beliefs: German Health Practices and French Canadian Heritage. https://nursingbird.com/health-care-beliefs-of-people-of-german-and-french-canadian-heritage/

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1. NursingBird . "Healthcare Practices and Beliefs: German Health Practices and French Canadian Heritage." August 11, 2023. https://nursingbird.com/health-care-beliefs-of-people-of-german-and-french-canadian-heritage/.

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NursingBird . "Healthcare Practices and Beliefs: German Health Practices and French Canadian Heritage." August 11, 2023. https://nursingbird.com/health-care-beliefs-of-people-of-german-and-french-canadian-heritage/.

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The German Healthcare System: Key Aspects

The German Health Care System is among the most advanced healthcare systems that provide quality healthcare services, which are not only accessible, but also affordable. What makes the German Health Care System unique across the world is the nature of social health insurance that it offers to Germans. In Germany, social health insurance is mandatory for low- and middle-income earners, but voluntary to high-income earners (Greb, 2007). Thus, the health care system has a dual system of social health insurance, which comprises mandatory and voluntary insurance packages. Mandatory healthcare insurance covers about 80% of the population, while alternative private health insurance and special insurance cover the remaining section of the population.

The cost of healthcare services in Germany is cheap and reasonable because the level of income determines the cost. Although patients receive the same quality of healthcare services, premiums that people pay are independent of the number of dependents and age of an individual; however, they are dependent on the level of income (Ridic, Gleason, & Ridic, 2012). In addition to reduced cost of healthcare services due to social health insurance, the German Health Care System has enacted reforms, which have increased accessibility of healthcare services and reduced inequalities. Ozeqowski and Sundmacher (2012) report that the parliament passed the Care Structures Act (2012), which aims at facilitating cross-sectoral treatment, improving outpatient care, strengthening innovation, and decentralizing management. The reforms have reduced sectoral barriers and improved efficiency, and thus they have enhanced accessibility of healthcare services.

The limitation of the German Health Care System is that the premiums that social health care insurance charges are increasing at a higher rate than the rate at which income level increases (Greb, 2007). This means that social health insurance premiums would increase disproportionately over a long period. Another limitation is that both private and mandatory insurers receive equal quality of healthcare services from the general practitioners, yet private insurers pay higher premiums than mandatory insurers.

Although the German Health Care System provides quality healthcare services that are accessible and affordable, the system is gradually proving to be cost-ineffective when compared to other health care systems across the world. According to Oduncu (2013), the health care system is rationing healthcare services, as a way of reducing medical costs and increasing cost-effectiveness of the system. Regarding patient satisfaction, a study conducted in Germany reveals that patient satisfaction has been increasing gradually in the past 10 years, with 34% of patients rating the quality of healthcare services as excellent (Koch, Schurmann, & Sawicki, 2010). Increasing patient satisfaction occurs because patients have freedom to choose either specialist care or primary care services. Specialist care and primary care have equal number of healthcare providers (Schlette, Lisa, & Blum, 2009). In this view, the health care system provides quality healthcare services because it has sufficient specialists and primary care providers. Moreover, patients have the freedom of choosing their preferred healthcare providers and services.

Given the advancements that the German Health Care System has made over decades, the system is sustainable despite increasing healthcare costs. The costs of the German Health Care System have increased from 5.9% of gross domestic product in 1970 to 11.6% of gross domestic product in 2013 owing to the increase of the population (Schlette et al. , 2009). This means that the healthcare costs have doubled within a period of about 40 years. However, the health care system is undertaking massive reforms to improve efficiency of the system and significantly enhance sustainability of the system.

Greb, S. (2007). Private health insurance in Germany: Consequences of a dual system.  Health Policy, 3 (2), 29-37.

Koch, K., Schurmann, C., & Sawicki, P. (2010). The German Health Care System in international comparison. Deutsches Ärzteblatt International, 107 (24), 427-434.

Oduncu, S. (2013). Priority-setting, rationing and cost-effectiveness in the German Health Care System. Medicine, Health Care, and Philosophy, 16 (3), 327-339.

Ozechowski, S., & Sundmacher, L. (2012). Ensuring access to health care: Germany reforms supply structures to tackle inequalities. Health Policy, 106 (2), 105-109.

Ridic, G., Gleason, S., & Ridic, O. (2012). Comparisons of health care systems in the United States, Germany, and Canada. Materia Sociomedica, 24 (2), 112-120.

Schlette, S., Lisa, M., & Blum, K. (2009). Integrated primary care in Germany: The road ahead. International Journal of Integrated Care, 9 (14), 1-11.

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Comparing the German and American Health Care Systems

Quian Callender

Mhsa ‘18, health management and policy.

April 18, 2018

In March, I traveled to Germany with a group of University of Michigan Health Management and Policy students to learn more about the German health care system and how it compares to the health care system in the US.

"Despite spending the most on health care in the world, the US falls significantly below other countries, like Germany, in terms of health outcomes," says Jasmine Oesch, a second year Health Management and Policy student. "It was important for me to go to Germany in order to learn about how and why this is happening—whether it was a structural insurance-based system issue, different priorities, etc."

The US-German Excursion was formed and led by Dr. Andreas Schmidt of the University of Bayreuth in Bayreuth, Germany. The seven-day excursion gave my classmates and me the opportunity to explore the topics of health policy, social insurance, and German sentiment of health and health care. We were joined by students from the University of Bayreuth, the University of North Carolina at Chapel Hill and the University of Missouri, which allowed for a cross-cultural dialogue with lasting impact. "Such learning opportunities should probably be made available to all students in health management and policy," says Jersey Liang , professor of health management and policy and global public health at Michigan Public Health.

"Opportunities for international collaboration such as these are critical for fostering discussions and understandings of what our own health system can improve on," reflects first year Health Management and Policy student Peter Geppert. "Not only were the learning experiences invaluable, but the relationships forged on this trip between members of my own program, other US programs, and the German program will last a lifetime."

We visited many different associations and agencies, including the Federal Union of German Pharmacy (ABDA) to get a sense of pharmaceutical use and pricing in Germany. "The pharmacist occupation is tightly regulated compared to the US," notes second year student Constance Yang. "A pharmacy must be operated by a pharmacist, and consumers need prescriptions for medications that are typically over-the-counter in the US." These differences in policies result in differences in utilization and cost between the US and Germany.

We learned more about the German concept of solidarity. The young pay for the old; the rich pay for the poor; the healthy pay for the sick; singles pay for families.

 We also visited the Federal Joint Committee (G-BA), the highest decision-making body of the joint self-government of physicians, dentists, hospitals and health insurance funds in Germany.

Outside of policy and insurance, we had the opportunity to visit two hospitals, Klinikum Kulmbach in the state of Bavaria and Charite in Berlin. Klinikum Kulmbach, one of 360 hospitals in Bavaria, is a 150-bed hospital with about 20,000 residents in its catchment area. Most notable was its human capital structure. The hospital only has one executive—a CEO— compared to more than a dozen C-level executives in American hospitals, on average.

We were also surprised to learn about the limited scope of nursing in Germany. "The way the workforce is structured is completely different," says first year student Andrea Arathoon. "Nurses are not specialized, and do not have different degrees and levels like in the United States."

Charite in Berlin was structured much like an academic medical center in the US, with 7,000 medical, dental, and nursing students and 16,000 employees. As a result of the 2008 financial crisis, Charite restructured its operating model similarly to US models with cost centers and digitalization.

We had ample opportunity to talk with German students and get their perspective on their own health system. We learned more about the German concept of solidarity. The young pay for the old; the rich pay for the poor; the healthy pay for the sick; singles pay for families. When we asked the German students their opinion on Germany solidarity, it was a principle that they truly believed and held as a value.

On the final day, second year student John Crist, along with students from the University of North Carolina and the University of Missouri, presented a student perspective of the US health care system to the director of Inpatient Reimbursement Strategy for AOK, one of the largest insurers in Germany. Students presented on the trends of the number of hospitals decreasing and the shift from volume to value in which quality of care and outcomes are increasingly important.

In reflecting on his experience in Germany, second year student John Crist says, "Immersing myself in the German health system challenged my assumptions about the way things should be done and helped me see the strengths of the US system. Seeing the differences in inputs and outputs helped me identify opportunities for improvement in both systems."

Left to right: Jersey Liang, Ling Hung, Jasmine Oesch, Peter Geppert, Quian Callender, Constance Yang, John Crist, and Andrea Arathoon outside the Reichstag building in Berlin

Left to right: Andrea Arathoon, John Crist, Peter Geppert, Jasmine Oesch, Constance Yang, and Quian Callender outside Charite, the largest Academic Medical Center in Berlin

John Crist (right) presenting, along with students from the University of North Carolina and the University of Missouri, on the US health system for the director of Inpatient Reimbursement for Germany's largest Social Health Insurance Fund

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‘People mustn’t feel meat is being taken away’: German hospitals serve planetary health diet

A group of hospitals serve up a menu rich in plants – and say they have had few complaints

Patrick Burrichter did not think about saving lives or protecting the planet when he trained as a chef in a hotel kitchen. But 25 years later he has focused his culinary skills on doing exactly that.

From an industrial park on the outskirts of Berlin, Burrichter and his team cook for a dozen hospitals that offer patients a “planetary health” diet – one that is rich in plants and light in animals. Compared with the typical diet in Germany, known for its bratwurst sausage and doner kebab, the 13,000 meals they rustle up each day are better for the health of people and the planet.

“I’ve been a cook my whole life and have run many kitchens,” says Burrichter. “Now I want to do something sustainable.”

Getting people in rich countries to eat less meat is one of the hardest tasks in the shift to a cleaner economy. In Burrichter’s kitchen, the steaming vats of coconut milk dal and semolina dumpling stew need to be more than just cheap and healthy – they must taste so good that people ditch dietary habits built up over decades.

The biggest challenge, says Burrichter, is replacing the meat in a traditional dish. “The bite is the most important, and the flavour comes after that.”

Moderate amounts of meat can form part of a healthy diet, providing protein and key nutrients, but the average German eats twice as much as doctors advise – and many times more than the climate can handle. The meat and dairy industry pumps out 12% to 20% of the pollutants baking the planet and making weather more violent.

Unlike in the US, where the amount of meat eaten per person keeps rising, or the UK, where it is declining slowly, in Germany efforts to cut consumption have picked up pace. The proportion of people who eat meat every day fell from 34% in 2015 to 20% in 2023, according to a survey from the German agriculture ministry. Driven more by the dangers to their health than to the climate, close to half of respondents said they were trying to eat less meat.

In the leafy Berlin suburb of Zehlendorf, where Burrichter’s meals land on the plates of patients at Waldfriede hospital, staff say few people complained when they swapped to a planetary health menu. “The fact it was so uncomplicated came as a surprise to us,” says the hospital director, Bernd Quoß.

Patients on the wards of Waldfriede praise the choice of meals on offer. Martina Hermann, 75, says she has been inspired to cook more vegetables when she gets home. “When meals are seasoned well, I don’t miss meat at all,” she says.

Elke Steuber, 72, says she had already cut down on meat because of rheumatoid arthritis, and is happy to have discovered dishes such as dal. “I know curries but this was new to me and it tasted great,” she says.

Followers of the planetary health diet need not abandon animal products altogether. The guidelines, which were proposed by 37 experts from the EAT-Lancet Commission in 2019, translate to eating meat once a week and fish twice a week, along with more wholegrains, nuts and legumes.

Some people object to swapping sausage and schnitzel for tofu and chickpeas. Older men, in particular, can feel patronised when they see fewer meat options on the menu, says Cindy Heerling, a dietician at Waldfriede.

There are also voices of caution among doctors. They agree that eating less meat would lower disease in rich countries but have questioned whether the planetary health diet – due to be revised this year – offers enough micronutrients. A study last year found that the intake of vitamin B12, calcium, iron and zinc fell short of recommended values.

“We know micronutrient deficiencies are still a big issue in many places around the world, particularly low-income countries in which populations do not get access to a diverse diet,” says Jessica Fanzo, a co-author of the study and one of the experts on the EAT-Lancet Commission.

The Johannesstift Diakonie, a Christian social enterprise that runs the kitchen and several of the facilities it serves, estimates it saves 500 tonnes of CO 2 a year by cooking less meat – about as much as it saved from a recent shift to renewable energy. Its success in gaining acceptance among patients may hold lessons for politicians and CEOs who want to shrink their carbon footprints and save money on sick days.

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Cutting down on meat freed up money in the budget to buy fresh, local ingredients, says Janine Briese, the head of catering at Johannesstift Diakonie. “People must not have the feeling that meat is being taken away from them. You have to create tasty alternatives.”

In one sense, a chef with a well-stocked spice rack should have an easy time dazzling dinner guests in Germany, a nation whose favourite herb is parsley. But unlike in countries where plant-based dishes have the same cultural status as meat ones, says Burrichter, Germans want substitutes for meat they forgo.

“That’s the most difficult thing – finding a good replacement, or cooking a dish in such a way that the lack of meat goes unnoticed,” he says. “You can do a lot with a well-cooked bean or a sun-dried tomato.”

Fake meats have made his job easier. Replacements that were mocked a decade ago have improved in taste and texture – and come down in price – to the point where they are a common sight on supermarket shelves. Without advancements in alternatives made from soy, pea and wheat, the menu’s success would not have been possible, Briese says.

But unlike vegetables and wholegrains, the dietary benefits of processed meat substitutes are uncertain. Neither they nor their animal counterparts can be assumed to be an “inherently” healthier part of a diet, a report from the United Nations Environment Programme found last year, though fake meats also lower the risk of zoonotic diseases and antimicrobial resistance.

To encourage regular plant-based meals, the staff take care with the branding. They pitch trendy “bowls” and “porridge” to young patients using English names, but in retirement homes talk about Haferflockensuppe , an oaty soup that some older Germans view with nostalgia.

For a generation who grew up eating meat as a weekly treat, the premium placed on the Sunday roast has also helped acceptance.

Christiane Elsholz, 81, was born as bombs fell on Berlin during the second world war and grew up in the city when hunger was rife. It took her a while to adjust to the hospital menu but she appreciates the thought put into the dishes.

“My mother was a trained chef and always told me ‘a good cook can make a lot out of a little’,” she says.

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There’s a Reason They’re Called ‘Gut’ Feelings

I n the 1800s, a French Canadian named Alexis St. Martin was shot in the stomach while at a fur trading post, when someone’s musket accidentally fired at close range. He survived, but his injuries resulted in a hole in his stomach wall. This provided an early window—literally—into how our emotions and mental health affect the gut. Through careful experiments, the surgeon William Beaumont discovered that St. Martin’s mental state had direct physiological consequences on his stomach’s activity: when he felt irritable, for example, his digestion slowed. Somehow, his emotional states were manifest in the specific, local biology of his gut.

Most people have experienced the gut consequences of their emotional feelings. Nerves before an exam might lead you to feel nauseous or even vomit. Profound sadness might make you lose your appetite, or perhaps cause a hunger impossible to satiate. Gut symptoms are common in mental health conditions, from appetite changes in depression to debilitating “psychosomatic” stomach pains. Many of our feelings are gut feelings.

But the gut doesn’t just respond to emotional feelings: it influences them, too. Take disgust. Disgust is visceral. Our stomach, like our heart, has a regular electrical rhythm; even just seeing something disgusting causes disruptions, called “dysrhythmias,” in this electrical signalling. Although disgust is crucial for survival—helping us avoid disease and stay alive—in many mental health conditions disgust becomes pathological. In obsessive compulsive disorder (OCD), for instance, dirt or germs can preoccupy someone’s thoughts, causing symptoms like compulsive hand-washing. Self-disgust is common in depression and eating disorders. And even post-traumatic disorder can be brought on by profoundly disgusting traumas.

Pathological disgust is particularly hard to treat : exposure therapy and other psychological approaches are much less effective than for fear-based mental health problems. A couple years ago, working as a neuroscientist at the University of Cambridge, I wondered if abnormal signals from the stomach could be causing disgust avoidance. I ran an experiment to test this hypothesis, and found that changing someone’s gut activity with a common anti-nausea drug reduced their disgust avoidance . This could represent a new way of treating pathological disgust in mental health disorders. For example, an anti-nausea drug could be administered just before exposure therapy, enabling patients to engage with therapy under a more optimal gut state.

Read More: How I Learned to Listen to What My Gut Was Telling Me

So gut feelings are not “all in your mind”—but they are not “all in your gut,” either. Sensations from the gut are transmitted to the brain via the vagus nerve, the primary channel of information sent from the body to the brain. A second route to target “gut feelings” is by electrically stimulating this nerve, which changes the electrical rhythm of the stomach . That said,  the idea is not new: vagus nerve stimulation for patients with major depression dates back to 2000 .

A new theory published in November 2023 proposes that vagus nerve stimulation amplifies signals from the internal body to the brain, which helps us adapt our behaviour to its current challenges and needs. That could explain why the effects of vagus nerve stimulation are so wide-reaching, altering learning, memory, and motivation. That means amplifying signals from the gut using vagus nerve stimulation might improve mental health in some cases, but in others could be ineffective or even detrimental. Ultimately, we need to consider the state and needs of someone’s internal body before amplifying the body’s influence on the brain.

But the importance of the vagus nerve extends to even more established treatments: evidence from mice suggests that the most common type of antidepressant drugs (SSRIs, or selective serotonin reuptake inhibitors) require the vagus nerve to work. This, too, could begin to provide clues why antidepressants do, or don’t, work for a given person, and even help us understand why they might cause side effects in some people.

If the vagus nerve’s role helps us adapt to our bodily needs, perhaps the most important internal need of all is energy. One function of the gut—together with other organs—is metabolism, converting food to energy the body can use. There are mysterious and wide-ranging connections between our metabolic system and mental health. For example, the prevalence of depression in people with diabetes is two or three times higher than in the general population. It’s not clear why: diabetes could increase depression risk, or vice versa. My lab is currently testing a third possibility: that common metabolic factors might increase your risk of both depression and diabetes because of interactions between the body and the brain. If we’re right, this could open up avenues toward metabolic interventions that improve both physical and mental health.

Our brain and wider nervous system adapts to its circumstances, including the body’s internal, metabolic needs, as well as our experience of the environment around us. Because of this, your gut-brain connection is not static, but rather changes and adapts over time. A fascinating study in 2021 discovered that brain cells can re-activate gut inflammation that an animal has previously experienced. The mere “memory” of gut inflammation, stored in cells in the brain, induced the physical state in the body. So sometimes a “gut feeling” actually originates from the brain. This role of the brain in “gut feelings” means our brain has the capacity to produce dysfunctional gut symptoms via brain changes alone. This ability of the brain could have upsides as well, perhaps explaining why psychological therapy—which causes brain changes —can also treat some gut conditions .

Gut feelings originate from many sources: directly through the gut, through channels of communication between gut and brain, or even through the brain itself. In neuroscience, as we unravel the dynamic communications between gut and brain, we can begin to understand how these processes helped our ancestors survive—and how we could better harness them to improve emotional and mental wellbeing. A gut feeling might have many possible causes, but each of these represent a potential solution for mental health.

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Germany has legalized possession of small amounts of cannabis. Not everyone is mellow about that.

Marijuana campaigners in Germany lit celebratory joints on Monday as the country liberalized rules on cannabis to allow possession of small amounts.

People smoke marijuana cigarette in front of the Brandenburg Gate during the ‘Smoke-In’ event in Berlin, Germany, Monday, April 1, 2024. Starting 1 April, Germany has legalised cannabis for personal use. As per the new law, Adults aged 18 and over will be allowed to carry up to 25 grams of cannabis for their own consumption. (AP Photo/Ebrahim Noroozi)

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People smoke marijuana in front of the Brandenburg Gate during the ‘Smoke-In’ event in Berlin, Germany, Monday, April 1, 2024. Starting 1 April, Germany has legalised cannabis for personal use. As per the new law, Adults aged 18 and over will be allowed to carry up to 25 grams of cannabis for their own consumption. (AP Photo/Ebrahim Noroozi)

A man takes a puff from a marijuana cigarette next to a placard reading “We don’t want to be offenders!” in front of the Brandenburg Gate during the “Smoke-In” event in Berlin, Germany, Monday, April 1, 2024. Starting 1 April, Germany has legalised cannabis for personal use. As per the new law, Adults aged 18 and over will be allowed to carry up to 25 grams of cannabis for their own consumption. (AP Photo/Ebrahim Noroozi)

A man takes a puff from a marijuana cigarette in front of the Brandenburg Gate and a placard reading “We don’t want to be offenders!” during the ‘Smoke-In’ event in Berlin, Germany, Monday, April 1, 2024. Starting 1 April, Germany has legalised cannabis for personal use. As per the new law, Adults aged 18 and over will be allowed to carry up to 25 grams of cannabis for their own consumption. (AP Photo/Ebrahim Noroozi)

A man takes a puff from a marijuana cigarette in front of the Brandenburg Gate during the ‘Smoke-In’ event in Berlin, Germany, Monday, April 1, 2024. Starting 1 April, Germany has legalised cannabis for personal use. As per the new law, Adults aged 18 and over will be allowed to carry up to 25 grams of cannabis for their own consumption. (AP Photo/Ebrahim Noroozi)

FRANKFURT, Germany (AP) — Marijuana campaigners in Germany lit celebratory joints on Monday as the country legalized possession of small amounts of cannabis for recreational use over objections from doctors and police.

The German Cannabis Association, which campaigned for the new law, staged a “smoke-in” at Berlin’s landmark Brandenburg Gate when the law took effect at midnight. Other public consumption events were scheduled throughout the country, including one in front of the Cologne cathedral and others in Hamburg, Regensburg and Dortmund.

Germany becomes the third European Union country to legalize cannabis for personal use after Malta and Luxembourg. The government argued that legalization would undermine criminal trade in the drug, guard against harmful impurities, and free police to pursue more serious crimes while providing for protections against use by under-18s.

The new law legalizes possession by adults of up to 25 grams (nearly 1 ounce) of marijuana for recreational purposes and allows individuals to grow up to three plants on their own. Use is prohibited within 100 meters (109 yards) of the entrance to a playground or school. That part of the legislation took effect Monday.

German residents age 18 and older will be allowed to join nonprofit “cannabis clubs” with a maximum 500 members each starting July 1. Individuals will be allowed to buy up to 25 grams per day, or a maximum 50 grams per month — a figure limited to 30 grams for people under age 21. Membership in multiple clubs won’t be allowed.

AP AUDIO: Germany has legalized possession of small amounts of cannabis. But the buzz may not last.

AP correspondent Charles de Ledesma reports Germany has legalized the possession of small amounts of marijuana - but buzz may be short-lived.

The clubs’ costs will be covered by membership fees, which are to be staggered according to how much marijuana members use.

The legislation also calls for an amnesty under which sentences for cannabis-related offenses that will no longer be illegal are to be reviewed and in many cases reversed. Regional authorities worry that the judicial system will be overburdened by thousands of cases.

Over the past 20 years, the general trend has been for European Union member countries to reduce cannabis penalties in various ways, according to the European Monitoring Centre for Drugs and Drug Addiction.

Those could include making possession a civil offense or diverting offenders to treatment instead of the criminal justice system, or less strict enforcement. In the Netherlands, cannabis remains illegal but sale of small amounts in so-called coffee shops is tolerated by the public prosecution service. A number of countries in Europe permit medical cannabis under differing sets of rules.

The law was passed by the current coalition of Chancellor Olaf Scholz’ Social Democrats, the Greens and the pro-business Free Democrats, against opposition from some of Germany’s federal states and the center-right Christian Democrats.

Christian Democratic leader Friedrich Merz has vowed that his party will reverse the legislation if it wins national elections expected in the fall of 2025. Any likely new government coalition, however, would include one of the parties that supported the law.

Leading garden stores surveyed by the dpa news agency indicated they would not be adding cannabis plants to their horticultural offerings. The German Medical Association opposed the law, saying it could have “grave consequences” for the “developmental and life prospects of young people in our country.” So did the union representing German police officers, which called it “the wrong signal.”

An expert's guide to Frank Auerbach: three must-read books (and a film) on the German-British painter

All you ever wanted to know about auerbach, from a biography by one of his sitters to a collection of essays about his drawings—selected by the courtauld gallery curator barnaby wright.

Out of the limelight: an early photo of the famously reclusive Auerbach in his studio Heritage Image Partnership Ltd/Alamy Stock Photo

• Click here for more reading lists on the world's greatest artists The Berlin-born, London-based artist Frank Auerbach is famously reclusive, rarely doing interviews and for much of his career has worked away diligently in his London studio. He is associated with the School of London alongside friends and peers such as Francis Bacon, Leon Kossoff and Lucian Freud. Kossoff sat for Auerbach and is one of the intimate charcoal drawings from the late 1950s and early 60s that have been brought together at the Courtauld Gallery in London for an exhibition titled Frank Auerbach: the Charcoal Heads (until 27 May). The exhibition’s curator Barnaby Wright has selected three books and a film to help us get closer to the life and work of Frank Auerbach.

Courtesy Rizzoli International Publications

Frank Auerbach (2022 revised edition) by William Feaver

“This book is the comprehensive account of Auerbach’s work to date. As well as being a writer on art, William Feaver has sat for Auerbach over many years and his introduction and interview with the artist share a wealth of insights. The book’s extensive catalogue section illustrates all the paintings and large-scale drawings Auerbach has made—more than 1,000 at the time of publication. Looking through these gives a sense of how Auerbach’s intense scrutiny over decades of a small number of sitters and areas of London he knows intimately, has given rise to a huge variety of paintings and drawings.”

Courtesy Yale University Press

Frank Auerbach: Drawings of People (2022), edited by Mark Hallett and Catherine Lampert

“Drawing has always been fundamental to Auerbach’s way of working. Surprisingly, this is the first book to focus specifically on his drawings. It takes the form of a series of essays by a range of writers who approach Auerbach’s drawing practice from different vantage points. These range from essays that look in detail at the moves, marks and layers of Auerbach’s drawings, to others that situate his work in expanded historical and cultural contexts.”

Courtesy Thames and Hudson Ltd

Frank Auerbach: Speaking and Painting (2019) by Catherine Lampert

“Catherine Lampert has been a sitter for Auerbach for over 40 years. She has written extensively on his art and organised his major retrospective exhibitions. This important book is rooted in the numerous conversations she has had with Auerbach and offers a richly detailed and illuminating account of his art and life. The book brings you close to the artist whilst offering a deeply informed account of the development of his art and ideas.”

© Hannah Rothschild

Frank Auerbach: To the Studio (2001 film), co-produced by Jake Auerbach and Hannah Rothschild

“Jake Auerbach has made a series of remarkable films about art and artists. This is one of two films he has made about his father (the other being Frank , 2015)—and both are as important as anything written on Auerbach for deepening our understanding of the artist and his work. To the Studio features interviews not only with Auerbach but also with his small group of long-term sitters. Hannah Rothschild’s interview with Auerbach elicits responses that are both insightful and deeply poignant.”

• Frank Auerbach: the Charcoal Heads , Courtauld Gallery, London, until 27 May

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Press Release  Attorney General's Office Announces Statewide Summer Youth Jobs Grant Program Focused On Public Health

Media contact   for attorney general's office announces statewide summer youth jobs grant program focused on public health, max german, deputy press secretary.

Boston — Attorney General Andrea Joy Campbell announced today that her office has made available up to $375,000 to continue the Healthy Summer Youth Jobs Grant Program (HSYJ). Now in its tenth year, the grant program will promote public health in local communities while providing summer employment and professional development opportunities for youth workers.  

HSYJ provides funding for organizations that enable young people to have a direct impact in their communities by working in jobs that promote healthy living, disease prevention, and good nutrition. Participants also enrich their own professional development with on-the-job training, skills development, and career planning.   

Examples of jobs offered by organizations that are funded through this grant program include:  

• Building and maintaining a community garden or urban farm;  
• Addressing food security and wellness needs of low-income communities;  
• Providing educational content on the environment and local natural resources; and  
• Instructing youth on wellness and recreational activities.  

The AG’s Office is funding this grant through a health care-related settlement received by the AGO and will operate across the Commonwealth of Massachusetts to provide valuable employment opportunities to young people.  

Grant awards will fund youth employment from July 1, 2024 through August 30, 2024. Interested applicants can visit the AG’s website for more information and for application instructions. Applications must be received by 5 p.m. on Friday, April 19, 2024.  

This matter was handled by Nathan Gardner, Anthony Zero, and Allison Beaufort from the Attorney General’s Grants team.  

Office of the Attorney General 

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